Background:
In spastic paresis, the respective contributions to active function of
antagonist hypoextensibility, spasticity, and impaired descending
command remain unknown.
Objectives: We explored correlations between
ambulation speed and coefficients of shortening, spasticity and,
weakness for three lower limb extensors.
Methods: This
retrospective study identified 140 subjects with chronic hemiparesis
(>6 months since injury) assessed during a single visit with barefoot
10-meter ambulation at comfortable and fast speed, and measurements of
passive range of motion (XV1), angle of catch at fast stretch (XV3) and active range of motion (XA) against the resistance of gastrocnemius, rectus femoris, and gluteus maximus. Coefficients of shortening (CSH=[XN-XV1]/XN; XN, normal expected amplitude based on anatomical values), spasticity (CSP=[XV1-XV3]/XV1), and weakness (CWK=[XV1-XA]/XV1) were derived. For each muscle, multivariable analysis explored CSH, CSP, and CWK as potential predictors of ambulation speed.
Results: Ambulation speed was 0.62±0.28m/s (mean±SD, comfortable) and 0.84±0.38m/s (fast) and was correlated with CSH and CWK against gastrocnemius (CSH, comfortable, ns; fast, β=−0.20, p=.03; CWK, comfortable, β=−0.21, p=.010; fast, β=−0.21, p =.012), rectus femoris (CSH, comfortable, β=−0.41, p=6E−7; fast, β=−0.43, p=5E−7; CWK, comfortable, β=−0.36, p=5E−5; fast, β=−0.33, p=.0003) and gluteus maximus (CSH, comfortable, β=−0.19, p=.02; fast, β=−0.26, p=.002; CWK, comfortable, β=−0.26, p=.002; fast, β=−0.22, p=.010). Ambulation speed was not correlated with CSP.
Conclusions:
In chronic hemiparesis, ambulation speed correlates with coefficients
of shortening and of weakness in lower limb extensors, but not with
their spasticity level. This may encourage therapists to focus treatment
primarily on muscle shortening by stretching programs and on impaired
descending command by active training.(Where is the stroke protocol for that?)
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