Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, MS, USA.
Arch Phys Med Rehabil. 2010 Jan;91(1):30-4. doi: 10.1016/j.apmr.2009.08.148. Epub 2009 Nov 13.
Horn TS, Yablon SA, Chow JW, Lee JE, Stokic DS. Effect of intrathecal baclofen bolus injection on lower extremity joint range of motion during gait in patients with acquired brain injury.
To evaluate lower extremity joint range of motion (ROM) during gait before and after intrathecal baclofen (ITB) bolus administration, and to explore the relation between changes in ROM and concurrent changes in gait speed and muscle hypertonia.
Case series.
Tertiary care rehabilitation center.
Adults (N=28) with muscle hypertonia due to stroke, trauma, or anoxia.
50-microg ITB bolus injection via lumbar puncture (75 and 100microg in 2 cases).
Ashworth score, self-selected gait speed, and sagittal plane ROMs in hip, knee, and ankle joints before and 2, 4, and 6 hours after ITB bolus.
A significant decrease in the mean Ashworth score on the more involved side (2.0 to 1.3) and an increase in gait speed (41 to 47cm/s) were noted at different intervals after ITB bolus injection. Ankle ROM significantly increased on the more involved (13 degrees to 15 degrees , P<.01) and less involved (22 degrees to 24 degrees , P<.05) sides. ROM significantly improved, significantly worsened, or showed no significant change in 42%, 34%, and 24% of individual joints, respectively. The peak change in ROM did not coincide with the peak decrease in Ashworth score. Peak changes in ROM and speed coincided more often (P<.001) in participants who increased gait speed after ITB bolus compared with those who decreased speed. The absolute change in ROM after ITB bolus injection correlated better with the concurrent changes in speed (r=.41, P<.001) than with the baseline speed (r=.18, P<.05).
ITB bolus injection produces variable changes in joint ROM during gait, with significant improvements in the ankles only. Timing and magnitude of peak changes in ROM are associated with concurrent changes in speed but not muscle hypertonia.
霍恩 TS、雅布隆 SA、周 JW、李 JE、斯托基奇 DS。鞘内巴氯芬推注对脑损伤后患者步态时下肢关节活动范围的影响。
评估鞘内巴氯芬（ITB）推注前后步态时下肢关节活动范围（ROM），并探讨 ROM 变化与同时发生的步态速度和肌肉张力亢进变化之间的关系。
病例系列。
三级康复中心。
因中风、创伤或缺氧而出现肌肉张力亢进的成年人（N=28）。
腰椎穿刺 50 微克 ITB 推注（2 例为 75 和 100 微克）。
Ashworth 评分、自我选择的步行速度和 ITB 推注前 2、4 和 6 小时矢状面髋关节、膝关节和踝关节的 ROM。
ITB 推注后不同时间点，受累侧平均 Ashworth 评分（2.0 至 1.3）显著降低，步行速度（41 至 47cm/s）增加。受累（13 度至 15 度，P<.01）和未受累（22 度至 24 度，P<.05）侧踝关节 ROM 显著增加。42%、34%和 24%的个体关节 ROM 分别显著改善、显著恶化或无明显变化。ROM 的峰值变化与 Ashworth 评分的峰值下降不一致。与速度降低的参与者相比，ITB 推注后增加速度的参与者的 ROM 和速度的峰值变化更吻合（P<.001）。与基线速度（r=.18，P<.05）相比，ITB 推注后 ROM 的绝对变化与同时发生的速度变化相关性更好（r=.41，P<.001）。
ITB 推注在步态时产生关节 ROM 的变化，仅踝关节有明显改善。ROM 峰值变化的时间和幅度与同时发生的速度变化相关，但与肌肉张力亢进无关。
