title: Effect of botulinum toxin injection in the rectus femoris on stiff-knee gait in people with stroke: a prospective observational study.
abstract: OBJECTIVE
  To study the effect of botulinum toxin type A (BTX-A) injection in the rectus femoris on the decreased knee flexion during the swing phase of gait (stiff-knee gait) in people with stroke.
  
  
  METHODS
  Intervention study (before-after trial) with an observational design.
  
  
  METHODS
  Outpatient rehabilitation clinic and gait laboratory.
  
  
  METHODS
  Nineteen chronic hemiparetic adults presenting with stiff-knee gait.
  
  
  METHODS
  Injection of 200 U of BTX-A (Botox) into the rectus femoris.
  
  
  METHODS
  Before and 2 months after BTX-A rectus femoris injection: Stroke Impairment Assessment Set (SIAS), Duncan-Ely test, and an instrumented gait analysis.
  
  
  RESULTS
  Median SIAS score improved from 53 (range, 36-65) to 57 (range, 42-70) (signed-rank test, P=.005) and the Duncan-Ely score from 3 (range, 1-3) to 1 (range, 0-3) (P<.001). In gait analysis, mean (+/- standard deviation) maximum knee flexion improved from 26 degrees +/-13 degrees to 31 degrees +/-14 degrees during the swing phase (paired t test, P<.001), knee flexion speed at toe-off improved from 82 degrees +/-63 degrees to 112 degrees +/-75 degrees/s (P=.009), and knee negative joint power (eccentric muscular contraction) improved from -.27+/-.23 to -.37+/-.26 W/kg (P<.001). The 4 patients who almost did not flex the knee (<10 degrees) before the BTX-A rectus femoris injection did not improve after the injection. The other 14 patients who flexed the knee more than 10 degrees before the BTX-A rectus femoris injection decreased the walking energy cost from 5.4+/-1.6 to 4.6+/-1.3 J x kg(-1) x m(-1) (P=.006).
  
  
  CONCLUSIONS
  BTX-A rectus femoris injection may be beneficial in patients with a stiff-knee gait after stroke, particularly in patients with some knee flexion (>10 degrees).
authors.affiliation: Rehabilitation and Physical Medicine Unit, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Gaëtan G
authors.initials: GG
authors.lastname: Stoquart
authors.forename: Christine
authors.initials: C
authors.lastname: Detrembleur
authors.forename: Sara
authors.initials: S
authors.lastname: Palumbo
authors.forename: Thierry
authors.initials: T
authors.lastname: Deltombe
authors.forename: Thierry M
authors.initials: TM
authors.lastname: Lejeune
mesh_terms: D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D004576:Electromyography; D005260:Female; D005684:Gait / Q000187:drug effects*; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D011446:Prospective Studies; D052097:Quadriceps Muscle / Q000187:drug effects*; D016059:Range of Motion, Articular; D020521:Stroke / Q000503:physiopathology*; D000071939:Stroke Rehabilitation
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A