F-1-04-05
BIOMECHANICAL CHANGES IN POST-CVA SPASTIC HEMIPLEGIC GAIT AFTER BOTULINUM NEUROLYSIS (BN) OF THE ANKLE PLANTAR FLEXORS
S Sharma, A Morris, K Parker, L Sheil, J Somerville, S Naumann (University of Toronto - Toronto, Canada)
Spasticity causes sustained ankle plantar flexion ( PF ) in hemiplegic subjects, and in the chronic stage, it may also lead to abnormal mechanics (hyperextension) of the knee leading to pain, instability, and osteoarthritis of the joint. There is no direct evidence that decreasing the tone of the gastrosoleus muscles corrects hyperextension of the knee joint.
A case of hemiplegic spastic foot was studied electro-diagnostically, kinetically, and kinematically before and four weeks after the BN of gastrosoleus muscles.
Ankle dorsiflexion improved by 428.9%. Knee hyperextension decreased by 60.61%. Positive changes occurred in ankle PF and hip flexion-extension. The M-response area recorded from the injected muscles increased by 50-60%. The M/H ratio improved by 56.2%. The surface EMG of the PF muscles matched the kinetic changes.
BN of gastrosoleus muscles is effective in reducing the knee hyperextension by changing the ankle mechanics which can be used to facilitate the rehabilitation of spastic hemiplegic subjects.
F-1-04-06
FEMORAL NERVE BLOCK FOR STIFF-LEGGED GAIT PATTERN IN SPASTIC PATIENTS
Heui Je Bang, Duk Hyun Sung, Jung Yi Kwon (Samsung Medical Center, Seoul, Korea)
The purposes of this study were to classify the pattern of dynamic EMG activities during swing phase and to evaluate the effects of femoral nerve block and motor point block of rectus femoris as a therapeutic modality in patients who walk stiff-legged due to spasticity of quadriceps muscle (15 hemiparesis and 6 paraparesis).
Dynamic EMG activities of 21 patients who had been hemiparetic or paraparetic for more than 6 months were analyzed before treatment by using fine wire electrodes inserted in the vastus medialis, rectus femoris, and vastus lateralis. Patterns of dynamic EMG activity were classified as only rectus femoris firing type, all of the 3 muscles firing type, and vasti firing type. The patients who had been improved by femoral nerve block with 2% lidocaine were treated by 5% phenol nerve block to rectus femoris branch of femoral nerve, botulinum toxin injection to rectus femoris, or 5% phenol motor point block to rectus femoris. The improvement in gait performance was assessed before and atier treatment with subjective and objective data using three dimensional gait analysis system (VICON 370).
Femoral nerve block was more effective in improving gait performance in those having EMG activity pattern of only rectus femoris firing without vasti activities during preswing to midswing phase than others. The above treatment methods may be effective therapeutic modalities to improve gait performance for stiff-legged gait pattern due to spasticity of rectus femoris.
