So you described a problem but failed to do ONE DAMN THING to solve it? That is pure incompetence! Stroke research should get survivors recovered!
Does Limited Dorsiflexion during Swing Phase in Hemiparesis Depend on Spasticity?
Maria Vinti * , Mathias Blandeau * , Hélène Pillet , Wafa Skalli , Philippe Decq , Andrea Merlo ,
Jean-Michel Gracies , Nicolas Bayle , Mouna Ghédira , Emilie Hutin
Posted Date: 19 February 2024
doi: 10.20944/preprints202402.0932.v1
Jean-Michel Gracies , Nicolas Bayle , Mouna Ghédira , Emilie Hutin
Posted Date: 19 February 2024
doi: 10.20944/preprints202402.0932.v1
Maria Vinti PhD 1, *, Mathias Blandeau PhD 2, *, Hélène Pillet PhD 3, Wafa Skalli PhD 3,
Philippe Decq MD 3,4, Andrea Merlo PhD 5, Jean-Michel Gracies MD PhD 6,7,
Nicolas Bayle MD 6,7, Mouna Ghédira PhD 6,7 and Emilie Hutin PhD 6,7
1 Univ. Limoges, HAVAE, UR 20217, F-87000 Limoges, France
2 Univ. Polytechnic Hauts-de-France, CNRS, UMR 8201 LAMIH, F-59313, Valenciennes, France
3 Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Sciences et Technologies, Paris,
France
4 AP-HP, Service de Neurochirurgie, Hôpital Beaujon, Clichy, 92 France
5 LAM–Motion Analysis Laboratory, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di
Reggio Emilia, San Sebastiano Hospital, Correggio (RE), Italy
6 UR 7377 BIOTN, Université Paris-Est Créteil (UPEC), F-94000 Créteil, France
7 Laboratoire Analyse et Restauration du Mouvement, AP-HP, Service de Rééducation Neurolocomotrice,
Hôpitaux Universitaires Henri Mondor, F-94000 Créteil, France
* Correspondence: mariaconcetta.vinti@unilim.fr (M.V.); mathias.blandeau@uphf.fr (M.B.)
Philippe Decq MD 3,4, Andrea Merlo PhD 5, Jean-Michel Gracies MD PhD 6,7,
Nicolas Bayle MD 6,7, Mouna Ghédira PhD 6,7 and Emilie Hutin PhD 6,7
1 Univ. Limoges, HAVAE, UR 20217, F-87000 Limoges, France
2 Univ. Polytechnic Hauts-de-France, CNRS, UMR 8201 LAMIH, F-59313, Valenciennes, France
3 Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Sciences et Technologies, Paris,
France
4 AP-HP, Service de Neurochirurgie, Hôpital Beaujon, Clichy, 92 France
5 LAM–Motion Analysis Laboratory, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di
Reggio Emilia, San Sebastiano Hospital, Correggio (RE), Italy
6 UR 7377 BIOTN, Université Paris-Est Créteil (UPEC), F-94000 Créteil, France
7 Laboratoire Analyse et Restauration du Mouvement, AP-HP, Service de Rééducation Neurolocomotrice,
Hôpitaux Universitaires Henri Mondor, F-94000 Créteil, France
* Correspondence: mariaconcetta.vinti@unilim.fr (M.V.); mathias.blandeau@uphf.fr (M.B.)
Abstract:
Plantar flexors (PF) spasticity is known to poorly correlate with active dorsiflexion (DF)
impairment throughout the swing phase of hemiparetic gait. Spastic Cocontraction, instead,
stemming from descending pathways, potentially misdirect antagonist PF activity opposing DF
during swing. Electromyographic (EMG) recordings, while unable to differentiate between
reflex-based and descending origins, may offer valuable insights into this distinction by exploring
PF EMG activity after tibial nerve neurotomy (which eliminates PF spasticity). Eleven subjects with
hemiparesis walking at comfortable velocity and 11 controls walking at comfortable and slow
velocity, underwent kinematic and PF/DF EMG analysis. Five of the hemiparetic subjects
underwent tibial neurotomy >1 year prior. We evaluated spasticity at rest (Tardieu scale), maximal
ankle dorsiflexion, tibialis anterior agonist recruitment and gastrocnemius medialis and soleus
cocontraction coefficients during swing. At slow velocity, controls (0.80±0.12 m/s) moved at a
similar pace as hemiparetic subjects (0.73±0.37 m/s, NS). Hemiparetic subjects showed: (i) reduced
ankle DF across swing (ii) increased PF cocontraction, including before any DF (iii) higher
cocontraction despite absent spasticity in tibial neurotomy subjects (iv) higher tibialis anterior
recruitment. Increased PF cocontraction occurs in the absence of spasticity or ankle DF despite
higher agonist recruitment. Spastic cocontraction is a major factor limiting active DF at swing,
unlike spasticity.
impairment throughout the swing phase of hemiparetic gait. Spastic Cocontraction, instead,
stemming from descending pathways, potentially misdirect antagonist PF activity opposing DF
during swing. Electromyographic (EMG) recordings, while unable to differentiate between
reflex-based and descending origins, may offer valuable insights into this distinction by exploring
PF EMG activity after tibial nerve neurotomy (which eliminates PF spasticity). Eleven subjects with
hemiparesis walking at comfortable velocity and 11 controls walking at comfortable and slow
velocity, underwent kinematic and PF/DF EMG analysis. Five of the hemiparetic subjects
underwent tibial neurotomy >1 year prior. We evaluated spasticity at rest (Tardieu scale), maximal
ankle dorsiflexion, tibialis anterior agonist recruitment and gastrocnemius medialis and soleus
cocontraction coefficients during swing. At slow velocity, controls (0.80±0.12 m/s) moved at a
similar pace as hemiparetic subjects (0.73±0.37 m/s, NS). Hemiparetic subjects showed: (i) reduced
ankle DF across swing (ii) increased PF cocontraction, including before any DF (iii) higher
cocontraction despite absent spasticity in tibial neurotomy subjects (iv) higher tibialis anterior
recruitment. Increased PF cocontraction occurs in the absence of spasticity or ankle DF despite
higher agonist recruitment. Spastic cocontraction is a major factor limiting active DF at swing,
unlike spasticity.
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