Article

OBJECTIVE: To find more accurate indices that could affect decisions in
spasticity treatment by investigating the relation between ultrasonographic,
electromyographic, and clinical parameters of the gastrocnemius muscle in adults
with spastic equinus after stroke. DESIGN: Observational study. SETTING: University hospitals. PARTICIPANTS: Chronic patients with stroke with spastic
equinus (N=43). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES:
Ultrasonographic features were spastic gastrocnemius muscle echo intensity,
muscle thickness, and posterior pennation angle of the gastrocnemius medialis
(GM) and gastrocnemius lateralis (GL) in both legs. Electromyographic evaluation
included compound muscle action potentials (CMAPs) recorded from the GM and GL of
both legs. Clinical assessment of the spastic gastrocnemius muscle was performed
with the Modified Ashworth Scale (MAS) and by measuring ankle dorsiflexion
passive range of motion (PROM). RESULTS: Spastic muscle echo intensity was
inversely associated with proximal (GM and GL: P=.002) and distal (GM and GL:
P=.001) muscle thickness, pennation angle (GM: P< .001; GL: P=.01), CMAP (GM:
P=.014; GL: P=.026), and ankle PROM (GM: P=.038; GL: P=.024). The pennation angle
was directly associated with the proximal (GM and GL: P< .001) and distal (GM:
P=.001; GL: P< .001) muscle thickness of the spastic gastrocnemius muscle. The
MAS score was directly associated with muscle echo intensity (GM: P=.039; GL:
P=.027) and inversely related to the pennation angle (GM and GL: P=.001) and
proximal (GM: P=.016; GL: P=.009) and distal (GL: P=.006) muscle thickness of the
spastic gastrocnemius. CONCLUSIONS: Increased spastic muscle echo intensity was
associated with reduced muscle thickness, posterior pennation angle, and CMAP
amplitude in the gastrocnemius muscle. Building on previous evidence that these
instrumental features are related to botulinum toxin response, these new findings
may usefully inform spasticity treatment decisions.
CI - Copyright (c) 2014 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS