Roche Nicolas, Zory Raphaël, Sauthier Antoine, Bonnyaud Celine, Pradon Didier, Bensmail Djamel
Services de Physiologie - Explorations Fonctionnelles, Médecine Physique et de Réadaptation et Centre d'Innovation Technologique, Hôpital Raymond Poincaré, AP-HP, Garches, France.
J Rehabil Med. 2015 Jan;47(1):31-7. doi: 10.2340/16501977-1887.
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.
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.
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.
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.
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.
肉毒杆菌毒素注射用于治疗中风后的痉挛。尽管这种治疗对肌肉张力有效，但其对与功能性步态相关活动的影响仍不确定。
这项随机对照试验的目的是确定自我康复计划作为肉毒杆菌毒素注射辅助手段对慢性偏瘫患者步态相关活动的影响。
纳入35名门诊患者。每位患者随机分为两组中的一组：肉毒杆菌毒素+标准化自我康复计划（R组，n = 19）或仅肉毒杆菌毒素（C组，n = 16）。每位患者在肉毒杆菌毒素注射前和注射后1个月接受以下测试评估：10米定时步行、起立行走测试、在生态环境中6分钟内行走的距离以及楼梯测试。
与C组相比，R组有显著改善：最大步态速度提高了8%（p = 0.003）；在生态环境中6分钟内行走的距离增加了7.1%（p = 0.01）；上、下一段楼梯的时间分别减少了9.8%（p = 0.003）和6.6%（p = 0.009）。自我康复计划耐受性良好且安全。
这些结果有力地表明，标准化自我康复计划是肉毒杆菌毒素注射的有益辅助手段，有助于改善与步态相关的活动。
