title: Improvement of upper trunk posture during walking in hemiplegic patients after injections of botulinum toxin into the arm.
abstract: BACKGROUND
  It has been hypothesized that altered trunk movements during gait in post-stroke patients or children with cerebral palsy are compensatory to lower limb impairment. Improvement of trunk movements and posture after injections of botulinum toxin into the affected arm would be at variance with this hypothesis and hint towards a multifactorial trunk control deficit.
  
  
  METHODS
  Clinical gait analysis was performed in 11 consecutively recruited hemiplegic patients immediately before and 4weeks after a botulinum toxin type A-injection into the affected arm. Kinematic data were collected using an 8 camera optical motion-capturing system and reflective skin-markers were attached according to a standard plug-in-gait model. Deviation of the trunk in lateral and forward direction and the trajectory of the C7-marker in a sacrum-fixed horizontal plane were analyzed in addition to classical gait parameters. The Wilson-signed-rank test was used for pre/post-botulinum toxin comparisons.
  
  
  RESULTS
  After botulinum toxin injections a significant improvement of forearm flexion scores from 2.57 to 2.0 (p<0.014), and a reduced lateral deviation of the upper trunk from 3.5degrees to 2.5degrees (p<0.014) were observed. Free-walkers tended to walk faster (p<0.046, 1-sided), with reduced pre-swing duration of both legs and an increased step length of the non-affected leg. The C7-marker trajectory was shifted towards the midline.
  
  
  CONCLUSIONS
  Injections of botulinum toxin into the affected arm of hemiplegic patients improve abnormal trunk lateral flexion. This shift of the center of mass of the upper body towards the midline improves various gait parameters including gait speed.
authors.affiliation: Department of Neurology, University of Düsseldorf, Moorenstrasse 5, D-40225 Düsseldorf, Germany. Electronic address: harald.hefter@online.de.
authors.forename: Harald
authors.initials: H
authors.lastname: Hefter
authors.affiliation: Department of Neurology, University of Düsseldorf, Moorenstrasse 5, D-40225 Düsseldorf, Germany.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Rosenthal
mesh_terms: D000368:Aged; D001132:Arm; D001696:Biomechanical Phenomena; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000503:physiopathology* / Q000534:rehabilitation*; D006429:Hemiplegia / Q000209:etiology / Q000503:physiopathology* / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D011187:Posture / Q000502:physiology*; D016059:Range of Motion, Articular; D020521:Stroke / Q000150:complications; D060726:Torso / Q000502:physiology*; D016138:Walking
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Botulinum neurotoxin; Hemiplegic gait; Stroke; Trunk muscles; Upper trunk posture