Article

OBJECTIVE: To determine the effect of motor branch block (MBB) or neuromuscular
block (NMB) of the rectus femoris on knee kinematics during swing, functional
outcome, and energy cost in adults with spastic paresis presenting a stiff knee gait.
DATA SOURCES: PubMed, Embase, CINAHL, and Cochrane Library were searched.
Studies were collected up to February 26, 2013. Reference lists were additionally
scrutinized. STUDY SELECTION: No restrictions were applied regarding study
design. Patients were adults suffering from a central neurological disorder.
Interventions had to include MBB or NMB. Outcome measures had to include knee
kinematics during the swing phase. Study selection was independently performed by
2 reviewers. DATA EXTRACTION: Two reviewers independently assessed the
methodological quality of included studies. Data on kinematics, functional
outcome, and energy cost from patients with stroke were extracted from the total
population and when possible pooled. DATA SYNTHESIS: A total of 9 articles
describing 12 different studies were included. Knee kinematics (peak knee flexion
or knee range) during swing improved significantly in all the included studies.
The average increase in peak knee flexion varied from 1.9 degrees to 15.4 degrees
. Data pooling of peak knee flexion in patients with stroke showed a significant
improvement of 7.37 degrees (P=.000) in NMB studies and of 9.35 degrees (P=.002)
in MBB studies. Data pooling of knee velocity at toe-off showed a significant
improvement of 53.01 degrees /s in NMB studies. In MBB studies, this improvement
was not significant. Data pooling of knee range of motion, functional outcomes,
and energy cost showed no significant difference. CONCLUSIONS: According to this
review, chemodenervation of the rectus femoris shows a significant improvement in
peak knee flexion during swing. The effect on functional outcomes and energy cost
is still unclear.
CI - Copyright (c) 2014 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS