Zwissig C1,2,3, Hennemann C1,4, Opsommer E2, Malatesta D1
1University of Lausanne (UNIL), Institute of Sport Sciences (ISSUL), Lausanne, Switzerland, 2School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland, 3CHUV, Physiotherapy, Department of Clinical Neurosciences (DNC), Lausanne, Switzerland, 4Geneva University Hospitals (HUG), Department of Intensive Care (APSI), Geneva, Switzerland
Background: Community ambulation is one of the most important goals for stroke patients. The spasticity of ankle plantarflexors is primary factor associated with reduced gait speed and walking endurance in chronic stroke. Botulinum toxin injection (BTI) represents the gold standard therapy for focal spasticity. However, it remains unclear whether BTI is really effective in functional improvements. Walking abilities are frequently secondary outcomes and are often poorly investigated.
Purpose: The aim of this study was to assess influence of BTI in ankle plantarflexors on preferred walking speed (PWS) and gait endurance in chronic stroke patients.
Methods: Twelve participants (55.6 ± 11.6 years; 6.5 ± 2.7 years since stroke) were assessed before and one month after BTI. PWS and spatiotemporal parameters of gait were measured using two wearable inertial sensors during a 10-Meter Walk Test. Gait endurance was assessed with a 6 minutes walk test. Passive ankle dorsiflexion, Motricity Index, Modified Ashworth Scale, Functional Ambulation Categories, Voorrips questionnaire and Barthel Index were also evaluated.
Results: One month after BTI, PWS was significantly improved from 0.66 m/s to 0.78 m/s (+ 18%, p = 0.04, small effect size). Gait endurance showed a non-significant improvement from 268 to 289 m (p = 0.13, less than small effect size). A significant improvement was found on passive ankle dorsiflexion (p = 0.031, small effect size) and on MAS in ankle plantarflexors (p = 0.004, medium effect size). The other outcomes showed no significant effect.
Conclusion(s): BTI alone improves PWS in chronic stroke patients but has no effect on gait endurance.
Implications: It would interesting to assess combination of BTI with aerobic training and specific strengthening exercises. This association would optimize the effect of BTI on gait endurance in chronic stroke patient.
Keywords: Stroke, Botulinum toxin, Gait
Funding acknowledgements: None
Purpose: The aim of this study was to assess influence of BTI in ankle plantarflexors on preferred walking speed (PWS) and gait endurance in chronic stroke patients.
Methods: Twelve participants (55.6 ± 11.6 years; 6.5 ± 2.7 years since stroke) were assessed before and one month after BTI. PWS and spatiotemporal parameters of gait were measured using two wearable inertial sensors during a 10-Meter Walk Test. Gait endurance was assessed with a 6 minutes walk test. Passive ankle dorsiflexion, Motricity Index, Modified Ashworth Scale, Functional Ambulation Categories, Voorrips questionnaire and Barthel Index were also evaluated.
Results: One month after BTI, PWS was significantly improved from 0.66 m/s to 0.78 m/s (+ 18%, p = 0.04, small effect size). Gait endurance showed a non-significant improvement from 268 to 289 m (p = 0.13, less than small effect size). A significant improvement was found on passive ankle dorsiflexion (p = 0.031, small effect size) and on MAS in ankle plantarflexors (p = 0.004, medium effect size). The other outcomes showed no significant effect.
Conclusion(s): BTI alone improves PWS in chronic stroke patients but has no effect on gait endurance.
Implications: It would interesting to assess combination of BTI with aerobic training and specific strengthening exercises. This association would optimize the effect of BTI on gait endurance in chronic stroke patient.
Keywords: Stroke, Botulinum toxin, Gait
Funding acknowledgements: None
Topic: Neurology: stroke
Ethics approval required: Yes
Institution: Swiss Ethics Committees on research involving humans
Ethics committee: Ethics Committee Vaud
Ethics number: (ID 2016-00471)
All authors, affiliations and abstracts have been published as submitted.
