Gait changes following botulinum toxin A treatment in stroke.
OBJECTIVE
To characterize the effects of botulinum toxin A treatment of spastic plantar flexors in stroke on joint mobility and gait kinematics and kinetics.


METHODS
Nine patients with hemiparetic stroke presenting with ankle hypertonicity participated in this exploratory open-label case series study. Comprehensive gait analysis provided bilateral kinematic and kinetic information for the ankle, knee, and hip joints throughout the stance phase. Data were obtained at baseline, 2 weeks, and 10 weeks post botulinum toxin injection of the spastic plantar flexors.


RESULTS
Passive ankle range of motion increased post injection (p < .05). The amount of plantarflexion in late stance was significantly reduced (p < .05) while the maximum dorsiflexion increased in midstance at 10 weeks post treatment. The angular displacement profiles for the knee revealed that patients tended to display less hyperextension following treatment (p = .053). No significant changes in kinetic measures were found; however, case-by-case observations suggested that most patients experienced improvements in positive work production.


CONCLUSIONS
The findings indicate that botulinum toxin treatment results in improved joint mobility and ankle kinematics and, in some patients, increases in positive work, suggesting better gait performance.
Novak
Alison C
AC
Motor Performance Laboratory, School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada.
Olney
Sandra J
SJ
Bagg
Stephen
S
Brouwer
Brenda
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000843:Ankle Joint / Q000503:physiopathology; D001696:Biomechanical Phenomena / Q000187:drug effects / Q000502:physiology; D019274:Botulinum Toxins, Type A / Q000494:pharmacology* / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005684:Gait / Q000187:drug effects*; D006621:Hip Joint; D006801:Humans; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D016059:Range of Motion, Articular; D020521:Stroke / Q000188:drug therapy* / Q000503:physiopathology*; D016896:Treatment Outcome
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A