Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, 6541GX Nijmegen, The Netherlands.
J Rehabil Med. 2019 Jun 18;51(6):434-441. doi: 10.2340/16501977-2556.
To investigate the functional effects of bilateral botulinum toxin A treatment and subsequent stretching of spastic hip adductors on gait and reactive lateral stepping responses in patients with pure hereditary spastic paraplegia.
Explorative pre-post intervention study.
Twenty-five patients with pure hereditary spastic paraplegia.
Patients were treated with bilateral botulinum toxin A injections in the hip adductors and performed daily self-administered stretching exercises for 16 weeks. Before the intervention (T0), and 6 (T1) and 16 (T2) weeks thereafter, gait width, gait speed, and leg angles at first stepping-foot contact after lateral balance perturbations were assessed, as well as the corresponding success rates of reactive lateral steps.
Compared with baseline, gait width increased by 12.6% and 9.7% and comfortable gait speed by 8.3% and 11.5% at T1 and T2, respectively. In known perturbation directions, leg angles increased by 5.9% at T1 and 8.0% at T2, while success rates increased from 70% at baseline to 90% at T1 and T2. No effects were found for maximal gait speed or lateral stepping responses in unknown perturbation directions.
Bilateral botulinum toxin A treatment and subsequent stretching of the hip adductors may improve gait and reactive lateral stepping in patients with pure hereditary spastic paraplegia.
探讨双侧肉毒毒素 A 治疗联合痉挛髋内收肌后续牵伸对纯遗传性痉挛性截瘫患者步态和反应性横向跨步反应的功能影响。
探索性干预前后研究。
25 例纯遗传性痉挛性截瘫患者。
患者接受双侧髋内收肌肉毒毒素 A 注射治疗，并在 16 周内每天进行自我管理的牵伸运动。在干预前（T0）、6 周（T1）和 16 周（T2）后，评估步态宽度、步态速度以及横向平衡干扰后首次触地脚的腿部角度，以及反应性横向跨步的相应成功率。
与基线相比，T1 和 T2 时步态宽度分别增加了 12.6%和 9.7%，舒适步态速度分别增加了 8.3%和 11.5%。在已知的干扰方向，腿部角度在 T1 时增加了 5.9%，在 T2 时增加了 8.0%，而成功率从基线时的 70%增加到 T1 和 T2 时的 90%。在未知的干扰方向，最大步态速度或横向跨步反应均无变化。
双侧肉毒毒素 A 治疗联合后续牵伸髋内收肌可能改善纯遗传性痉挛性截瘫患者的步态和反应性横向跨步。
