title: Use of gait parameters to predict the effectiveness of botulinum toxin injection in the spastic rectus femoris muscle of stroke patients with stiff knee gait.
abstract: BACKGROUND
  Botulinum toxin type A (BTX-A) injection in the rectus femoris (RF) is commonly used to treat decreased peak knee flexion in swing phase of the gait in hemiplegic patients. However, the effect of BTX-A varies between 5° to 10° depending on the studies. Peak knee flexion also increases during fast gait and could constitute a way to predict the effect of BTX-A injection in the RF.
  
  
  OBJECTIVE
  To determine if changes in gait parameters during fast gait before injection could predict the effect of RF BTX-A injection on peak knee flexion in hemiplegic patients.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  A neurological rehabilitation department in a university hospital
  
  
  METHODS
  Twenty two hemiplegic patients with stiff knee gait mainly due to spasticity of the RF and treated by RF-BTX-A-injection.
  
  
  METHODS
  Patients' gait was analyzed using a 3D motion analysis system and force plates. The gait recordings were performed before (PRE-RF-BTX-A:spontaneous and fast gait speed) and one month after RF-BTX-A-injection (POST-RF-BTX-A:spontaneous gait speed). Correlations between the percentage change in gait parameters during fast gait before RF-BTX-A-injection and the percentage increase in peak knee flexion POST-RF-BTX-A injection at spontaneous speed were analyzed.
  
  
  RESULTS
  The percentage improvement in peak knee flexion in the fast gait condition before injection was the only parameter correlated with the percentage increase in peak knee flexion POST-RF-BTX-A injection. This was confirmed by a stepwise linear regression. The percentage increase in peak knee flexion POST-RF-BTX-A injection was also correlated with the percentage increase in knee flexion angular velocity at toe-off in the fast gait condition.
  
  
  CONCLUSIONS
  The percentage increase in peak knee flexion in swing during fast gait before injection is a useful predictor of the increase in peak knee flexion following RF BTX-A injection in chronic stroke patients with RF spasticity.
  
  
  CONCLUSIONS
  In stroke patients with SKG which is mainly caused by spasticity of the RF muscle, evaluating changes which occur during fast gait might help the therapist to identify patients who would benefit the most from BTX-A injection in the RF muscle.
authors.affiliation: Service of lof Physiology and Functional Exploration, University of Versailles Saint Quentin en Yvelines, Hôpital Raymond Poincaré, Garches, France - Roche.nicolas@rpc.aphp.fr.
authors.forename: N
authors.initials: N
authors.lastname: Roche
authors.forename: J
authors.initials: J
authors.lastname: Boudarham
authors.forename: A
authors.initials: A
authors.lastname: Hardy
authors.forename: C
authors.initials: C
authors.lastname: Bonnyaud
authors.forename: B
authors.initials: B
authors.lastname: Bensmail
mesh_terms: D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D005684:Gait / Q000502:physiology*; D020233:Gait Disorders, Neurologic / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007273:Injections, Intramuscular; D007719:Knee Joint / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D009465:Neuromuscular Agents / Q000008:administration & dosage; D011446:Prospective Studies; D052097:Quadriceps Muscle / Q000187:drug effects / Q000503:physiopathology*; D016059:Range of Motion, Articular / Q000502:physiology; D020521:Stroke / Q000150:complications*; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A