UR 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), Créteil, France.
AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, Créteil, France.
PLoS One. 2024 Oct 24;19(10):e0310969. doi: 10.1371/journal.pone.0310969. eCollection 2024.
Functional correlates of spastic myopathy, the muscle disorder of spastic paresis, are unknown.
To explore reciprocal relationships between clinical and structural parameters of plantar flexors with i) ambulation speed, ii) dorsiflexion and plantarflexion torques in chronic hemiparesis.
Cross-sectional trial in chronic stroke-induced hemiparesis (>6 months). Plantar flexors were quantified through i) the Five Step Assessment: maximal extensibility (XV1), active range of dorsiflexion (XA); ii) ultrasonography: fascicle length (Lf) and thickness (Th) of medial gastrocnemius (GAS) and soleus (SOL), knee extended in an isokinetic ergometer, ankle at 80% XV1-GAS. Maximal isometric torques in plantar flexion (PF) and dorsiflexion (DF) and maximal barefoot 10-meter ambulation speed were collected. Relationships between structural, biomechanical, clinical and functional parameters were explored using non-parametric testing (Spearman).
Twenty-one subjects (age 58.0±8.4, mean±SD, time since lesion 7.8±5.7 years) were recruited, with the following characteristics: ambulation speed, 0.77±0.37m/sec; XV1-SOL 92.7±10.3°; XV1-GAS 91.3±9.6°; XA-SOL 86.9±10.0°; XA-GAS 7676±14.2°; LfGAS, 58.2±18.3mm; ThGAS, 17.1±3.6 mm; LfSOL, 36.0±9.6 mm; ThSOL, 13.8±3.3mm; PF peak-torque 46.5±34.1Nm, DF peak-torque, 20.1±19.1Nm. XA-SOL and XA-GAS strongly correlated with XV1-SOL and XV1-GAS respectively (ρ = 0.74, p = 4E-04; resp ρ = 0.60, p = 0.0052). Ambulation speed moderately correlated with LfGAS (ρ = 0.51, p = 0.054), ThGAS (ρ = 0.58, p = 0.02) and LfSOL (ρ = 0.63, p = 0.009). DF and PF peak-torques both correlated with LfGAS (ρ = 0.53, p = 0.04) a; resp. ρ = 0.71, p = 0.0015).
In chronic hemiparesis, active dorsiflexion is mostly determined by plantar flexor extensibility. Plantar flexor fascicle shortening is associated with reduced ambulation speed and ankle torques. Attempts to restore plantar flexor extensibility might be important objectives for gait rehabilitation in chronic hemiparesis.
痉挛性偏瘫患者的肌肉疾病——痉挛性肌病的功能相关性尚不清楚。
探讨慢性偏瘫患者的足底屈肌的临床和结构参数与以下因素之间的相互关系：i）步行速度，ii）背屈和跖屈扭矩。
对慢性脑卒中引起的偏瘫（>6 个月）进行横断面试验。通过以下方式对足底屈肌进行量化：i）五步评估：最大伸展性（XV1）、主动背屈范围（XA）；ii）超声：内侧比目鱼肌（GAS）和跟腱（SOL）的肌纤维长度（Lf）和厚度（Th），在等速测力计中膝关节伸展，踝关节处于 80%XV1-GAS 位置。收集最大等速跖屈（PF）和背屈（DF）的峰值扭矩以及最大赤脚 10 米步行速度。使用非参数检验（Spearman）探索结构、生物力学、临床和功能参数之间的关系。
共纳入 21 名受试者（年龄 58.0±8.4，平均值±标准差，从损伤到研究开始的时间为 7.8±5.7 年），具有以下特征：步行速度为 0.77±0.37m/sec；XV1-SOL 为 92.7±10.3°；XV1-GAS 为 91.3±9.6°；XA-SOL 为 86.9±10.0°；XA-GAS 为 7676±14.2°；GAS 的 Lf 为 58.2±18.3mm；GAS 的 Th 为 17.1±3.6mm；SOL 的 Lf 为 36.0±9.6mm；SOL 的 Th 为 13.8±3.3mm；PF 峰值扭矩为 46.5±34.1Nm，DF 峰值扭矩为 20.1±19.1Nm。XA-SOL 和 XA-GAS 分别与 XV1-SOL 和 XV1-GAS 有很强的相关性（ρ=0.74，p=4E-04；分别为 ρ=0.60，p=0.0052）。步行速度与 GAS 的 Lf 中度相关（ρ=0.51，p=0.054）、GAS 的 Th（ρ=0.58，p=0.02）和 SOL 的 Lf（ρ=0.63，p=0.009）。DF 和 PF 峰值扭矩均与 GAS 的 Lf 相关（ρ=0.53，p=0.04）；分别为 ρ=0.71，p=0.0015）。
在慢性偏瘫中，主动背屈主要由足底屈肌的伸展性决定。足底屈肌肌纤维缩短与步行速度和踝关节扭矩降低有关。恢复足底屈肌伸展性可能是慢性偏瘫步态康复的重要目标。
