Surgical Intervention for Spastic Upper Extremity Improves Lower Extremity Kinematics in Spastic Adults: A Collection of Case Studies

Abstract

Methods: Three patients with an anoxic brain injury, upper extremity spasticity, and an altered gait participated in this study. A specific treatment plan based on the patient was tailored by the orthopedic hand surgeon to help release the contractures and spastic muscles. Three-dimensional gait analysis was performed before surgery, 3, 6, and 12 months postoperatively. During each experimental session, the patient walked at a self-selected pace in a straight line across four force plates embedded into the floor (Kistler R). Motion data were acquired using Vicon R Motion Capturing System. Spatiotemporal measurements as well as bilateral kinematics of the hip, knee and ankle were studied. The results from matched non-disabled controls were included as reference. Results: Overtime, clinical assessment displayed recovery in hand functions and restored sensation in the fingers. Gait analysis results demonstrated overall improvements in spatiotemporal parameters, specifically in cadence and walking speed. Improvements in kinematics of the lower limbs were also evident. Conclusion: The results of this study indicated that, within a timeframe of one year, gait patterns improved in all patients. These observations suggest that, over time, upper limb surgery has the potential to improve the biomechanics of gait in spastic patients.

The impact of upper limb spasticity-correcting surgery on the everyday life of patients with disabling spasticity: a qualitative analysis

“…Participants who used walking aids said they could more easily hold on to the aid, which they felt increased their walking capacity. This ameliorating effect was described after treatment of UL with botulinum toxin [39,40] and surgery [41]. Moreover, the participants also noted a generally improved posture when standing, sitting, and lying down.…”

A protocol to analyze the global literature on the clinical benefit of interlimb-coordinated intervention in gait recovery and the associated neurophysiological changes in patients with stroke

“…Studies that did not mention the screening of medications that might affect muscle tone. previous study reported spatiotemporal parameters of gait could be improved by releasing the upper extremity spasticity ( 46 ). therefore, the present study excluded trials that did not specifically screen the application of spasticity medication in accordance with a published study.…”

Surgical Treatment in Post-Stroke Spastic Hands: A Systematic Review

“…Among the 22 reviewed studies, 19 (86.36%) provided level III evidence, and 21 (95.45%) obtained a low or very low score on the GRADE scale (Table 3) [39,40] (Figure 2). Sixteen studies were retrospective case series [12,17,18,[21][22][23][24][26][27][28][29][30][31][32][33]37], two were single-center [25] or multi-center [38] retrospective cohort studies, three were prospective case series [34][35][36], and one was a randomized controlled trial [16]. Only three studies included a comparative group, formed by patients who were treated with rehabilitation in two [16,38] and those undergoing a different surgical technique in the third [25].…”

“…Only two articles studied candidates for functional surgery [26,29], reporting on a total of 56 patients (5.96% of patients in reviewed studies). In the remaining studies, the patient sample was mixed, with functional and nonfunctional hands or hands of unspecified status [21,28,30,[34][35][36][37][38]41]. None of the reviewed studies stratified their outcomes according to the etiology of the upper extremity spasticity or the patient profile.…”