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Botulinum Toxin Effect on Voluntary and Stretch Reflex-Related Torque Produced by the Quadriceps: An Isokinetic Pilot Study
Bernuz B, Genet FO, Terrat P, Pradon D, Barbot F, Bussel B, Bensmail D.
Neurorehabil Neural Repair. 2011 Dec 9. [Epub ahead of print]
Abstract
BACKGROUND :
An understanding of the mechanical effects of botulinum toxin type A (BoNT A) on spastic and voluntary muscle contraction may help predict functional responders.
OBJECTIVE:
To compare the effect of BoNT A on the voluntary and stretch reflex-related torques produced by activation of the rectus femoris (RF).
METHODS :
This was a prospective open study where 15 incomplete spinal cord injury patients, impaired by a stiff-knee gait, with RF hyperactivity in mid-swing quantified by formal gait analysis (GA), were assessed before and after RF BoNT A injection (Botox, 200 UI).
MAIN OUTCOME MEASURES :
Included isokinetic peak torque (and angle at peak torque) at 0° (supine) and 90° (seated) during passive stretch (10 deg/s, 90 deg/s, and 150 deg/s), and voluntary contraction (60 deg/s) of the quadriceps. Secondary measures included impairment by Modified Tardieu Scale (MTS), peak knee flexion and spatial-temporal data by GA, activity (6-minute walking test, timed stair climbing), and discomfort (Verbal Rating Scale).
RESULTS :
Voluntary torque decreased (-16%; P = .0004) but with only a trend toward a decrease in stretch reflex-related torque. The angle at spastic torque increased at 90 deg/s (+5°; P = .03), whereas MTS, peak knee flexion (+4°; P = .01), spatial-temporal data, timed stair climbing test (25%; P = .02), and discomfort were significantly improved.
CONCLUSION :
BoNT A appeared to delay the stretch-reflex angle at peak torque, whereas the voluntary torque decreased. After strict patient selection, BoNT A injection into the RF muscle led to improvements in impairment, activity, and discomfort.
Contact : Réhabilitation Neurologique, Hôpital Léon Bérard, Hyères ; Service de Médecine Physique et Réadaptation, Hôpital Raymond Poincaré, Garches
Self-catheterization acquisition after hand reanimation protocols in C5-C7 tetraplegic patients
Bernuz B, Guinet A, Rech C, Hugeron C, Even-Schneider A, Denys P, Barbot F, Chartier-Kastler E, Revol M, Laffont I.
Spinal Cord. 2011 Feb;49(2):313-7. Epub 2010 Sep 28.
STUDY DESIGN :
Case series from a prospectively acquired database and phone survey.
OBJECTIVES :
To assess the efficacy of upper limb reanimation (ULR) protocols on acquisition of intermittent self-catheterization (ISC) in C5-C7 ASIA tetraplegic patients.
SETTING :
University Hospital, Paris, France.
METHODS :
A prospectively acquired database of 152 tetraplegic patients followed in ULR consultation between 1997 and 2008 in a rehabilitation unit was studied. A total of 20 patients met the inclusion criteria, which mainly were traumatic C5-C7 tetraplegic adult patients who were unable to perform ISC, and who benefited from ULR with the objectives of improving hand abilities and of ISC acquisition, through urethral orifice for males or via a continent urinary stoma for females. The main outcome measure was ISC acquisition (ISC+) proportion. Population characteristics and secondary outcome measures: ISC+/ISC- patients were compared regarding epidemiological and surgical data, key-grip strength, patient global improvement score, activities of daily living and quality of life (PGI-I, Wuolle questionnaire, verbal rating scale).
RESULTS :
ISC+ was 75%. It depended on key-grip strength (P<0.05) and led to a statistically significant improvement of urinary status compared with ISC- patients (P<0.01). ULR improved patients' abilities and QoL in both ISC+ and ISC- patients.
CONCLUSION :
ULR protocols allow ISC in most C5-C7 tetraplegic patients. Multidisciplinary care with surgeons and PRM physicians improves patients' vital and functional prognosis by changing their urological-management method.
Contact : Réhabilitation Neurologique, Hôpital Léon Bérard ; Department of Physical Medicine and Rehabilitation, Raymond Poincare University Hospital, APHP, Versailles University, Garches, France
