Article

The aim of the present study was to understand how the improvement
of mechanical variables during gait is controlled by the central nervous system
after BoNT-A injections. Therefore, we used Kinematic Segmental Coordination
(KSC), i.e. the kinematic covariation law of elevation angles between lower limb
segments, to assess their effect on gait control. As far as we know, this has
never been studied before. METHODS: Twenty chronic hemiparetic stroke patients
presenting with a stiff-knee gait performed an instrumented gait analysis at the
same walking speed before and 2 months after BoNT-A injection in several spastic
muscles. We used the kinematic recordings previously obtained by Caty et al.
[Caty GD, Detrembleur C, Bleyenheuft C, Deltombe T, Lejeune TM. 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. Stroke 2008;39(October (10)):2803-8] and computed KSC
following Borghese's methodology. The treatment effect was tested using a
repeated measures ANOVA. RESULTS: BoNT-A injections allowed a statistically
significant improvement in KSC of both lower limbs (p=0.004). Moreover, the
unaffected side KSC reached normal values after BoNT-A injections. CONCLUSION : BoNT-A allowed an improvement in KSC of the affected lower limb and a
normalization of KSC of the unaffected limb. This improvement could either be due
to a mechanical effect or a central effect of BoNT-A via the spinal central
pattern generators (CPGs).
- Raideur du genou

Langue : ANGLAIS