Effect of Botulinum Toxin Injection in the Rectus Femoris on Stiff-Knee Gait in People With Stroke: A Prospective Observational Study

Stoquart, Gaëtan; Detrembleur, Christine; Palumbo, Sara; Deltombe, Thierry; Lejeune, Thierry

doi:10.1016/j.apmr.2007.08.131

Cited by 92 publications

(135 citation statements)

References 22 publications

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“…We chose to limit our study to the AIS patients with thoraco-lumbar and lumbar primary curves because deformities at these levels are anatomically related to the pelvis [7,15,27,32], an important determinant of gait that would be primarily affected [11,40]. This study group was well-defined with the Lenke classification [20] and comprised one of the largest series on untreated scoliosis assessed by a technically validated gait analysis.…”

Section: Discussionmentioning

confidence: 99%

Gait in adolescent idiopathic scoliosis: kinematics and electromyographic analysis

et al. 2009

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Adolescent idiopathic scoliosis (AIS) is a progressive growth disease that affects spinal anatomy, mobility, and left-right trunk symmetry. Consequently, AIS can modify human locomotion. Very few studies have investigated a simple activity like walking in a cohort of well-defined untreated patients with scoliosis. The first goal of this study is to evaluate the effects of scoliosis and scoliosis severity on kinematic and electromyographic (EMG) gait variables compared to an able-bodied population. The second goal is to look for any asymmetry in these parameters during walking. Thirteen healthy girls and 41 females with untreated AIS, with left thoracolumbar or lumbar primary structural curves were assessed. AIS patients were divided into three clinical subgroups (group 1 \ 20°, group 2 between 20 and 40°, and group 3 [ 40°). Gait analysis included synchronous bilateral kinematic and EMG measurements. The subjects walked on a treadmill at 4 km/h (comfortable speed). The tridimensional (3D) shoulder, pelvis, and lower limb motions were measured using 22 reflective markers tracked by four infrared cameras. The EMG timing activity was measured using bipolar surface electrodes on quadratus lumborum, erector spinae, gluteus medius, rectus femoris, semitendinosus, tibialis anterior, and gastrocnemius muscles. Statistical comparisons (ANOVA) were performed across groups and sides for kinematic and EMG parameters. The step length was reduced in AIS compared to normal subjects (7% less). Frontal shoulder, pelvis, and hip motion and transversal hip motion were reduced in scoliosis patients (respectively, 21, 27, 28, and 22% less). The EMG recording during walking showed that the quadratus lumborum, erector spinae, gluteus medius, and semitendinosus muscles contracted during a longer part of the stride in scoliotic patients (46% of the stride) compared with normal subjects (35% of the stride). There was no significant difference between scoliosis groups 1, 2, and 3 for any of the kinematic and EMG parameters, meaning that severe scoliosis was not associated with increased differences in gait parameters compared to mild scoliosis. Scoliosis was not associated with any kinematic or EMG left-right asymmetry. In conclusion, scoliosis patients showed significant but slight modifications in gait, even in cases of mild scoliosis. With the naked eye, one could not see any difference from controls, but with powerful gait analysis technology, the pelvic frontal motion (right-left tilting) was reduced, as was the motion in the hips and shoulder. Surprisingly, no asymmetry was noted but the spine seemed dynamically stiffened by the longer contraction time of major spinal and pelvic muscles. Further studies are needed to evaluate the origin and consequences of these observations.

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Section: Discussionmentioning

confidence: 99%

Gait in adolescent idiopathic scoliosis: kinematics and electromyographic analysis

et al. 2009

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“…The secondary aim was to analyze whether simultaneous BoNT A injections into several spastic muscles are more useful in the treatment of stiff knee gait, as opposed to 1 single injection into the RF. 7 …”

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confidence: 99%

“…The overactivity of the rectus femoris (RF) is often cited, 4,5 but the altered activity of other muscles could also take place in the physiopathology. 6 In a previous study, Stoquart et al 7 demonstrated that 200 U of Botulinum toxin type A (BoNT A, Botox) injected into the RF was effective at improving knee movement and the energy cost of walking. These authors focused on gait analysis and explored only the first ICF domain.…”

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confidence: 99%

Effect of Simultaneous Botulinum Toxin Injections Into Several Muscles on Impairment, Activity, Participation, and Quality of Life Among Stroke Patients Presenting With a Stiff Knee Gait

Caty

Detrembleur

Bleyenheuft

et al. 2008

Stroke

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Background and Purpose-Walking is an essential activity for daily life and social participation, and it is frequently limited after stroke. A lack of knee flexion during the swing phase (stiff knee) is one of the impairments that restrict walking ability among patients with hemiparetic spasticity. Our purpose was to study the effect of Botulinum toxin type A (BoNT A) injections in several spastic muscles on the impairment, activity, participation, and quality of life of patients with chronic stroke presenting with a stiff knee gait. Methods-Twenty chronic hemiparetic poststroke patients with stiff knee gait and ability to walk on a treadmill were recruited. BoNT A was injected into several spastic muscles: the rectus femoris (200 U), semitendinosus (100 U) and triceps surae (200 U). Patients' neurological impairments (Ashworth scale, Duncan-Ely test, Stroke Impairment Assessment Set, and instrumented gait analysis), activity (ABILOCO and 10-m walking test), and participation (SATISPART-Stroke and 36-item Short-Form Health Survey) were assessed before and 2 months after the injection. Results-BoNT A injection reduced the impairments. It improved Stroke Impairment Assessment

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“…After water seepage, peripheral perfusion improves, but reperfusion injury may occur, thereby leading to cardiovascular system injury (Lu et al, 2006). As heat loss in water is 3-fold higher than in air at the same temperature, local wound soaking with seawater below human body temperature also exacerbates tissue energy metabolism disorders (Stoquart et al, 2008). This series of local and systemic pathophysiological reactions are detrimental to fracture healing, which is manifested by slow endochondral ossification, an increased undesirable rate, and weakened healed fractured bone intensity (Yang et al, 2005).…”

Section: Discussionmentioning

confidence: 99%

“…However, considering that many bone fractures are accompanied by intraarticular fracture or have broken ends located around the joint, transarticular external fixation is necessary to achieve effective fixation (Wang et al, 2007). As such a treatment brings about long-term inactivity of the joint, it may affect joint functional restoration (Stoquart et al, 2008;van der Krogt et al, 2010). What influence will the external fixator bring about to the joint during its use?…”

Section: Introductionmentioning

confidence: 99%

Treatment of seawater immersion-complicated open-knee joint fracture

Ai¹,

Zhao²,

Gao³

et al. 2014

Genet. Mol. Res.

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ABSTRACT. The current study aimed to select suitable remedies for seawater immersion-complicated open-knee joint fracture by exploring the effects of different treatment methods. Forty adult rabbits weighing 2.20 ± 0.25 kg were divided equally into internal fracture fixation group (A), seawater-immersed group with primary internal fixation (B), seawater-immersed group with secondary internal fixation (C), and seawater-immersed group with external fixation (D), using the randomdigit table method. Open-femoral internal condylar fracture models were established. Group A was left untreated for 2 h, whereas the other three groups were subjected to seawater immersion for 2 h. Afterwards, groups A and B underwent debridement and steel plate and screw internal fixation. Group C underwent debridement and external fixation, which was followed by secondary steel plate and screw internal fixation after the wound healed. Group D underwent transarticular arthrodesis. Wound infection, joint functional rehabilitation, and radiological and histopathological changes in fracture healing in each group were assessed. The results showed that delayed internal fixation effectively

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Effect of Botulinum Toxin Injection in the Rectus Femoris on Stiff-Knee Gait in People With Stroke: A Prospective Observational Study

Cited by 92 publications

References 22 publications

Gait in adolescent idiopathic scoliosis: kinematics and electromyographic analysis

Gait in adolescent idiopathic scoliosis: kinematics and electromyographic analysis

Effect of Simultaneous Botulinum Toxin Injections Into Several Muscles on Impairment, Activity, Participation, and Quality of Life Among Stroke Patients Presenting With a Stiff Knee Gait

Treatment of seawater immersion-complicated open-knee joint fracture

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