Article

OBJECTIVES: To evaluate lower extremity joint range of motion (ROM) during gait before and after intrathecal baclofen (ITB) bolus
administration, and to explore the relation between changes in ROM and concurrent
changes in gait speed and muscle hypertonia. DESIGN: Case series. SETTING:
Tertiary care rehabilitation center. PARTICIPANTS: Adults (N=28) with muscle
hypertonia due to stroke, trauma, or anoxia. INTERVENTIONS: 50-microg ITB bolus
injection via lumbar puncture (75 and 100microg in 2 cases). MAIN OUTCOME MEASURES: Ashworth score, self-selected gait speed, and sagittal plane ROMs in
hip, knee, and ankle joints before and 2, 4, and 6 hours after ITB bolus.
RESULTS: A significant decrease in the mean Ashworth score on the more involved
side (2.0 to 1.3) and an increase in gait speed (41 to 47cm/s) were noted at
different intervals after ITB bolus injection. Ankle ROM significantly increased
on the more involved (13 degrees to 15 degrees , P<.01) and less involved (22
degrees to 24 degrees , P<.05) sides. ROM significantly improved, significantly
worsened, or showed no significant change in 42%, 34%, and 24% of individual
joints, respectively. The peak change in ROM did not coincide with the peak
decrease in Ashworth score. Peak changes in ROM and speed coincided more often
(P<.001) in participants who increased gait speed after ITB bolus compared with
those who decreased speed. The absolute change in ROM after ITB bolus injection
correlated better with the concurrent changes in speed (r=.41, P<.001) than with
the baseline speed (r=.18, P<.05). CONCLUSIONS: ITB bolus injection produces
variable changes in joint ROM during gait, with significant improvements in the
ankles only. Timing and magnitude of peak changes in ROM are associated with
concurrent changes in speed but not muscle hypertonia.
CI - Copyright (c) 2010 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS