Spastic cocontraction of plantar flexors during swing phase of gait in chronic hemiparesis

No clue what use this is going to be in getting you to 100% recovery. Bet your doctor doesn't either. Lots of fucking data but no content.
http://www.sciencedirect.com/science/article/pii/S1877065716302494

• Mouna Ghedira,
• Jean-Michel Gracies,
• Valentina Mardale,
• Catherine-Marie Loche,
• Inke Marie Albertsen,
• Nicolas Bayle,
• Emilie Hutin^,

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http://dx.doi.org/10.1016/j.rehab.2016.07.169

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Objective

In spastic hemiparesis, quantify agonist recruitment of tibialis anterior and triceps surae spastic cocontraction during swing phase of gait.

Material/Patients and methods

Thirty-seven subjects with chronic hemiparesis (49 ± 14 years, mean ± SD; time since lesion, 8 ± 7 years) performed a 3D gait analysis, barefoot at comfortable speed (10 optoelectronic cameras, 6 dynamometric force plates, analysis of 9 cycles), with bilateral electromyography of tibialis anterior (TA), soleus (SO) and gastrocnemius medialis (GM). Speed, step length and maximal active dorsiflexion during swing were measured. Indices of agonist recruitment, IRATA, and spastic cocontraction, ICCSO and ICCGM, were calculated over 3 periods of swing phase (T1, [0–33%]; T2, [34–66%]; T3, [67–100%]), by the ratio of the RMS of the electromyogram in the period of interest over the RMS of the electromyogram of the same muscle over 100 ms around the maximal agonist isometric activity (measured on standing position by a maximal effort against resistance). IRA and ICC were compared between the 3 periods and between paretic and non paretic sides using repeated measures MANOVA (significant effect, P < 0.05).

Results

Speed, 0.68 ± 0.26 m/s; paretic step length, 0.48 ± 0.12 m, non paretic, 0.43 ± 0.15 m; paretic maximal active dorsiflexion, −3 ± 8°, non paretic, 6 ± 4°.

On the paretic side: IRATA decreased between T1 and T2 (T1, 0.69 ± 0.59; T2, 0.48 ± 0.39, P = 2E-4) and then remained unchanged at T3 (0.47 ± 0.45; vs T1, P = 1E-4; vs T2, ns), while ICCSO and ICCGM increased at T3 only (ICCSO, T2, 0.25 ± 0.21; T3, 0.57 ± 0.50; P = 5E-8; ICCGM, T2, 0.39 ± 0.40; T3, 0.59 ± 0.50; P = 2E-4). On the non-paretic side, IRATA, ICCSO and ICCGM remained unchanged (IRATA, T1, 0.32 ± 0.20; T2, 0.23 ± 0.13; T3, 0.25 ± 0.10, ns; ICCSO, T1, 0.12 ± 0.12; T2, 0.13 ± 0.12; T3, 0.25 ± 0.18 ns; ICCGM, T1, 0.17 ± 0.31; T2, 0.19 ± 0.27; T3, 0.26 ± 0.25 ns). Side xperiod effect, P = 0.04.

Discussion - Conclusion

During comfortable gait in chronic hemiparesis, there is a decrease in tibialis anterior recruitment from mid-swing phase on and an increase in soleus and gastrocnemius spastic cocontraction at late swing were found.

Changes in the muscle-tendon complex of triceps surae after 1 year of rehabilitation including a daily self-stretch program in patients with chronic hemiparesis

Totally worthless since they didn't even bother to measure spasticity and the effects of this program on that. Bet your doctor has no clue what a guided Self-rehabilitation contract is? 

Changes in the muscle-tendon complex of triceps surae after 1 year of rehabilitation including a daily self-stretch program in patients with chronic hemiparesis

 

Abstract

Objective

To explore changes in muscle architectural parameters of the muscle-tendon unit of soleus and medial gastrocnemius (GM) in patients with chronic hemiparesis, after 1 year of rehabilitation.

Material/Patients and methods

In this prospective study, 20 chronic hemiparetic patients (8W, mean age: 56 [12], time since lesion 9 [8]) were evaluated. Muscle architectural parameters including muscle fascicle length, pennation angle, thickness, tendon and muscle belly lengths were evaluated in vivo using ultrasonography in passive condition (verified by electromyographic recording) in a seated patient with ankle, knee and hip on the paretic side at 90°. Following the biomechanical analysis, each patient benefited from the Five Step Assessment (FSA), involving the measure of XV1, angle of arrest at slow and strong stretch, which estimates soft tissue extensibility around each muscle. Four muscles of interest in the lower limb were selected for this measure: soleus (XV1Sol), medial gastro-soleus complex (XV1GSC), gluteus maximus (XV1GM) and rectus femoris (XV1RF). Biomechanical and clinical analyses were performed at the beginning and after 1 year of treatment. Two treatments were implemented:

– conventional rehabilitation (50%);

– guided Self-rehabilitation contract (GSC, 50%).

Patients in the GSC group were prescribed a daily self-stretch program with static (>10 min/muscle/day) and eccentric stretch. Changes in architectural parameters and clinical muscle extensibility of overall patients before and after 1 year of rehabilitation were analyzed (Student's).

Results

After 1 year, muscle fascicle length and thickness increased respectively by 6.1mm (14.2%, P=0.05), 1.8mm (13.6%, P=0.06) in soleus, and by 2.9mm (9.1%, P=0.04) and 1.7mm (13.2%, P=0.03) in MG. Muscle belly length of MG increased by 2.9cm (17%, P=0.0001) and its tendon length decreased by 0.82cm (5%, P=0.04). XV1GSC increased by 4.8° (3.3%, P=0.07), XV1GM by 4.1° (3.3%, P=0.0004) and XV1RF by 7.2° (6%, P=0.02).

Discussion - Conclusion

Stretch of soleus and medial gastrocnemius practiced over the long term in patients with spastic hemiparesis allowed structural changes, increasing muscle fascicle length and thickness. Muscle belly length of medial gastrocnemius also increased significantly while its tendon length decreased, suggesting that the tendon may adapt its length to the muscle length changes.