Article

There are no guidelines on the ideal time to inject botulinum toxin
type A (BT-A) for lower leg spasticity in stroke patients.
An early injection may
produce unwanted weakness, interfering with gait recovery. OBJECTIVE: To evaluate
whether the outcomes after BT-A injection for plantarflexion spasticity can be
different according to stroke chronicity. DESIGN: A secondary analysis study from
a double-blinded, randomized trial with group reclassification according to
stroke chronicity. SETTING:
Two rehabilitation centers. PARTICIPANTS: Stroke
participants (n = 40) with plantar flexor spasticity, treated with BT-A (200
units) into the gastrocnemius muscle. METHODS: Outcome parameters were reanalyzed
serially using 2-way repeated measures of analysis of variance (ANOVA), at
baseline and 2, 4, and 8 weeks postinjection. Subjects were reclassified into 3
groups: early, within 6 months (n = 12); middle, between 6 months and 1 year (n =
14); and late, between 1 and 2 years from stroke onset (n = 12). MAIN OUTCOME
MEASURES: The Modified Ashworth Scale, clonus scale, 10-m walking test, ABILOCO,
and the Functional Ambulation Category. RESULTS: The 2-way repeated measures of
ANOVA showed improvement in gait and spasticity after injection in the 3 groups.
Significant improvement in the Modified Ashworth Scale (P < .001) was observed,
starting from the post-2 week injection period. Improvement of gait as assessed
by the functional measurement ABILOCO and the Functional Ambulation Category (P <
.001) were observed in all 3 groups, mostly at the post-8 week injection period.
CONCLUSIONS: Our serial measurements of the outcome parameters indicated that
BT-A could be expected to lead to consistent improvement in both the muscle tone
and gait quality in those with plantar flexor spasticity regardless of stroke
chronicity, including those injected as early as within the first 6 months. LEVEL
OF EVIDENCE: I.
CI - Copyright (c) 2018 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc.
All rights reserved.
- Analyse en double aveugle

Langue : ANGLAIS