Nerve transfer in the spastic equino varus foot: Anatomical feasibility study

Diner, Constance; Laurent, Michel; Pfister, Georges; Mourtialon, Romain; Denormandie, P.; l’Escalopier, Nicolas de

doi:10.1016/j.fas.2023.04.001

Cited by 2 publications

(4 citation statements)

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“…Early research, including rat models of hemiplegia and pilot human studies, indicates promising recovery in limb function and spasticity reduction. Notably, an experiment on rats showed significant hindlimb recovery, and initial human cases reported improved muscle power in stroke patients following lumbar-to-sacral nerve transfer 51 , 52 , 77 , 78 . Despite these encouraging outcomes, the current body of evidence is small, highlighting the need for extensive clinical trials to validate these findings and explore their application across the diverse spectrum of brain injuries.…”

Section: Discussionmentioning

confidence: 99%

Peripheral nerve transfers for dysfunctions in central nervous system injuries: a systematic review

Xiang,

Wu,

et al. 2024

International Journal of Surgery

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Background: The review highlights recent advancements and innovative uses of nerve transfer surgery in treating dysfunctions caused by central nervous system (CNS) injuries, with a particular focus on spinal cord injury (SCI), stroke, traumatic brain injury, and cerebral palsy. Methods: A comprehensive literature search was conducted regarding nerve transfer for restoring sensorimotor functions and bladder control following injuries of spinal cord and brain, across PubMed and Web of Science from January 1920 to May 2023. Two independent reviewers undertook article selection, data extraction, and risk of bias assessment with several appraisal tools, including the Cochrane Risk of Bias Tool, the JBI Critical Appraisal Checklist, and SYRCLE’s ROB tool. The study protocol has been registered and reported following PRISMA and AMSTAR guidelines. Results: Nine hundred six articles were retrieved, of which 35 studies were included (20 on SCI and 15 on brain injury), with 371 participants included in the surgery group and 192 in the control group. These articles were mostly low-risk, with methodological concerns in study types, highlighting the complexity and diversity. For SCI, the strength of target muscle increased by 3.13 of Medical Research Council grade, and the residual urine volume reduced by more than 100 ml in 15 of 20 patients. For unilateral brain injury, the Fugl-Myer motor assessment (FMA) improved 15.14–26 score in upper extremity compared to 2.35–26 in the control group. The overall reduction in Modified Ashworth score was 0.76–2 compared to 0–1 in the control group. Range of motion (ROM) increased 18.4–80° in elbow, 20.4–110° in wrist and 18.8–130° in forearm, while ROM changed −4.03°−20° in elbow, −2.08°−10° in wrist, −2.26°−20° in forearm in the control group. The improvement of FMA in lower extremity was 9 score compared to the presurgery. Conclusion: Nerve transfer generally improves sensorimotor functions in paralyzed limbs and bladder control following CNS injury. The technique effectively creates a ‘bypass’ for signals and facilitates functional recovery by leveraging neural plasticity. It suggested a future of surgery, neurorehabilitation and robotic-assistants converge to improve outcomes for CNS.

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Section: Discussionmentioning

confidence: 99%

Peripheral nerve transfers for dysfunctions in central nervous system injuries: a systematic review

Xiang,

Wu,

et al. 2024

International Journal of Surgery

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“…Our results in this new population showed that parameter and criterion calculations are reproducible. Thus, the semiogram appears to be an easily accessible and reproducible complement that can be used to compare new surgical techniques with greater precision than a simple functional analysis [11]. The main limitations of the semiogram in our practice are mainly linked to the signi cant variation in parameters depending on the pathologies studied.…”

Section: Evaluation Methods In Sevf Surgerymentioning

confidence: 99%

“…GAS only gives a de nitive result at a distance but does not allow us to monitor the progressive evolution of gait postoperatively, or to assess even minimal changes in gait. On the other hand, the semiogram has an objective and quantitative character that may be useful when comparing two techniques or two therapies, such as a motor block and the e cacy of an intervention [48], or an innovative surgical procedure [11]. It would also be interesting to use it in the evaluation of temporary therapies such as botulinum toxin injections.…”

Section: Imu and Sevfmentioning

confidence: 99%

“…It allows to know if the functional contract established with the patient during the preoperative phase has been ful lled. Although it provides effective individual-level analysis, it is not very precise when it comes to comparing different treatments [11]. Thus, it seems essential to complete this functional evaluation with a global, quanti ed and objective evaluation of the repercussion of this procedure on the patients' gait [12].…”

Section: Introductionmentioning

confidence: 99%

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Inertial Measurement Units to evaluate the efficacity of Equino Varus Foot surgery in post stroke hemiparetic patients

de l'Escalopier,

Voisard,

Jung

et al. 2023

Preprint

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Introduction This study evaluates the gait analysis obtained by IMU before and after surgical management of Spastic Equino Varus Foot in hemiplegic post-stroke patients and to compare it with the functional results obtained in a monocentric prospective cohort. Methods Patients with post-stroke equinovarus foot, who underwent surgery in a single hospital between November 2019 and December 2021 were included. The follow-up duration was 6 months and included a functional analysis using Goal Atteinment Scale and a Gait analysis using an innovative Multidimensional Gait Evaluation using IMU: the semiogram. Results 20 patients had a gait analysis preoperatively and at 6 months postoperatively. 90% (18/20) patients had a functional improvement and 50% (10/20) had an improvement in walking technique as evidenced by the cessation of the use of a walking aid. Considering the semiogram, the measurement of the area weighted by average speed demonstrated very good reproducibility (ICC(1, 3) = 0.80). In the group with a positive functional outcome (GAS T score ≥ 50), the change in the area was + 9.5%, sd = 27.5% for the group with modification of walking aid, and + 15.4%, sd = 28% in the group without change of walking aid. For the 3 experiences (two patients) with unfavorable results, the area under the curve changed by + 2.3%, -10.2% and − 9.5%. Discussion IMUs appear to be a promising solution for the assessment of post-stroke hemiplegic patients who have undergone SEVF surgery. They can provide a quantified, objective, reliable in individual longitudinal follow up automated gait analysis solution for routine clinical use. Combined with a functional scale such as the GAS, they can provide a global analysis of the effect of surgery.

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Nerve transfer in the spastic equino varus foot: Anatomical feasibility study

Cited by 2 publications

References 11 publications

Peripheral nerve transfers for dysfunctions in central nervous system injuries: a systematic review

Peripheral nerve transfers for dysfunctions in central nervous system injuries: a systematic review

Inertial Measurement Units to evaluate the efficacity of Equino Varus Foot surgery in post stroke hemiparetic patients

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