title: Effect of rehabilitation and botulinum toxin injection on gait in chronic stroke patients: a randomized controlled study.
abstract: BACKGROUND
  Botulinum toxin injections are used to treat spasticity in stroke. Although this treatment is effective on muscle tone, its effect on functional gait-related activities remains uncertain.
  
  
  OBJECTIVE
  The aim of this randomized controlled trial was to determine the effect of a self-rehabilitation programme as an adjunct to botulinum toxin injections on gait-related activities in patients with chronic hemiparesis.
  
  
  METHODS
  Thirty-five outpatients were included. Each patient was randomized to 1 of 2 groups: botulinum toxin + standardized self-rehabilitation programme (R group, n = 19) or botulinum toxin alone (C group, n = 16). Each patient was evaluated with the following tests before botulinum toxin injections and one month afterwards: 10-m timed walk, Timed Up and Go, distance covered in 6 min over an ecological circuit, and the stair test.
  
  
  RESULTS
  There were significant improvements in the R group compared with the C group: maximal gait speed improved by 8% (p = 0.003); distance covered in 6 min over an ecological circuit increased by 7.1% (p = 0.01); and time to ascend and to descend a flight of stairs decreased by 9.8% (p = 0.003) and 6.6% (p = 0.009), respectively. The self-rehabilitation programme was well tolerated and safe.
  
  
  CONCLUSIONS
  These results strongly suggest that a standardized self-rehabilitation programme constitutes a useful adjunct to botulinum toxin injections in order to improve gait-related activities.
authors.affiliation: Services de Physiologie - Explorations Fonctionnelles, Médecine Physique et de Réadaptation et Centre d'Innovation Technologique, Hôpital Raymond Poincaré, AP-HP, Garches, France. roche.nicolas@rpc.aphp.fr.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Roche
authors.forename: Raphaël
authors.initials: R
authors.lastname: Zory
authors.forename: Antoine
authors.initials: A
authors.lastname: Sauthier
authors.forename: Celine
authors.initials: C
authors.lastname: Bonnyaud
authors.forename: Didier
authors.initials: D
authors.lastname: Pradon
authors.forename: Djamel
authors.initials: D
authors.lastname: Bensmail
mesh_terms: D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002908:Chronic Disease; D003131:Combined Modality Therapy; D005260:Female; D005684:Gait / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000188:drug therapy; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010291:Paresis / Q000503:physiopathology / Q000534:rehabilitation; D010349:Patient Compliance; D026741:Physical Therapy Modalities; D020127:Recovery of Function; D012648:Self Care / Q000379:methods; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D016138:Walking / Q000502:physiology
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A