Gastaldi L, Lisco G, Pastorelli S, Dimanico U
Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy -
Eur J Phys Rehabil Med. 2015 Oct;51(5):609-18. Epub 2014 Dec 18.
Nowadays, administration of botulinum neurotoxin type A is considered a safe, well tolerated and effective treatment for muscles tone reduction in focal spasticity care. Lack of evidence regards instead its functional role on gait parameters, as well patterns.
To assess the botulinum neurotoxin treatment efficacy on chronic poststroke subjects, in order to investigate its functional effects on spatio-temporal gait parameters, in addition to the evaluation of spasticity grade based on clinical scales.
A prospective open-label study along 16-weeks trials.
Outpatient neurophysiology rehabilitation structure and laboratory of movement and gait analysis.
Twenty chronic poststroke patients, suffering from equinovarus foot deformity, with a stabilized hemiparesis were recruited according to inclusion criteria of the protocol.
Single neurotoxin-based local intramuscular injections were given according to a specific protocol concerning both the considered muscles and the relative toxin doses, with a maximum total dose ranged between 200 U and 400 U. Patients were observed both at baseline (t0) and for 4 following monthly visits (t1, t2, t3, t4) after injections at baseline. Gait analysis sessions were performed at each visit, by means of a video-cameras based system and body reflective markers attached to the body, based on a protocol. Authors focus on both global and local gait temporospatial parameters, such as walking speed, stride-length, cadence, stride-time, step-width, single limb support, double support and limp index to point out the functional changes due to the treatment. For comparison prior to and after the treatment, clinical scales like Modified Ashworth Scale, Berg Balance Scale and Rivermead Mobility Index have been also considered.
Subsequent to the neurotoxin intramuscular injections, patients reported statistical significant gait improvements after 90 days (t3) regarding temporospatial parameters: (P<0.05) for walking speed, single limb support and double support and (P<0.10) for stride-length, stride-time, cadence and step-width.
The botulinum neurotoxin treatment has demonstrated its efficacy for a functional recovery of gait, as pointed out by a statistically significant improvement of some spatio-temporal parameters. Thus, the analyzed changes reveal an improved balance and self-confidence in gait. Studies involving a wider population data are nevertheless needed to better confirm this efficacy.
The poststroke botulinum neurotoxin-based treatment is a safe and potentially useful neurorehabilitative approach for the analyzed data.
如今，A型肉毒杆菌神经毒素被认为是一种安全、耐受性良好且有效的治疗方法，用于缓解局部痉挛护理中的肌肉紧张。然而，缺乏证据表明其对步态参数以及模式的功能作用。
评估肉毒杆菌神经毒素对慢性中风患者的治疗效果，以研究其对时空步态参数的功能影响，同时基于临床量表评估痉挛程度。
一项为期16周的前瞻性开放标签研究。
门诊神经生理学康复机构以及运动与步态分析实验室。
根据研究方案的纳入标准，招募了20名患有马蹄内翻足畸形且偏瘫病情稳定的慢性中风患者。
根据特定方案进行基于单一神经毒素的局部肌肉注射，涉及相关肌肉及相对毒素剂量，最大总剂量在200单位至400单位之间。在基线期（t0）以及基线期注射后接下来的4个月每月随访（t1、t2、t3、t4）时对患者进行观察。每次随访时通过基于视频摄像机的系统以及附着在身体上的身体反光标记进行步态分析，依据特定方案进行。作者关注整体和局部步态时空参数，如步行速度、步长、步频、步幅时间、步宽、单支撑、双支撑和跛行指数，以指出治疗引起的功能变化。为了比较治疗前后情况，还考虑了改良Ashworth量表、Berg平衡量表和Rivermead运动指数等临床量表。
在神经毒素肌肉注射后，患者在90天（t3）时报告时空参数方面步态有统计学显著改善：步行速度、单支撑和双支撑方面（P<0.05），步长、步幅时间、步频和步宽方面（P<0.10）。
肉毒杆菌神经毒素治疗已证明其对步态功能恢复有效，一些时空参数有统计学显著改善表明了这一点。因此，分析的变化显示步态中的平衡和自信心有所改善。然而，仍需要涉及更广泛人群数据的研究来更好地证实这种疗效。
基于肉毒杆菌神经毒素的中风后治疗对于所分析的数据是一种安全且潜在有用的神经康复方法。
