Article

Poor control of reaching in spastic hemiparetic patients could be
because of a combination of poor individuation of joints, weakness, spasticity,
and/or sensory loss. OBJECTIVE: To assess the effect of botulinum toxin
injections (BTIs) on spasticity, upper-limb function, and kinematics of reaching
movements in patients with spastic hemiparesis caused by brain injury. METHODS:
Fifteen patients with spastic hemiparesis and 9 healthy controls were included in
this single-site, open-labeled study. The trajectories of reaching movements were
recorded, and kinematic variables were computed.
A clinical evaluation included
the Motor Activity Log, the Action Research Arm Test (ARAT), and the Box and
Block Test (BBT). Patients were assessed before (M0), 1 month after a first (M1),
and 1 month after a second BTI (M4, at 4 months) in proximal and distal muscles.
RESULTS: Significant differences were found between hemiparetic patients and
healthy participants for all kinematic parameters. All parameters tended to
improve after BTI. This effect was significant for velocity and smoothness.
Functional scores also tended to improve. Improvements were greater at M4 than at
M1, although the differences were not significant. CONCLUSIONS: Kinematic
parameters improved following BTI, without significant changes in clinical
outcomes such as ARAT and BBT. The decrease in spasticity alone does not seem to
explain the results, which may be a result of adaptation to the decrease in
hypertonicity leading to increased use of the arm and possibly an increase in
antagonist muscle strength.

Langue : ANGLAIS