Article

Hemiplegic patients with supraspinal spasticity can present with a
flexor pattern at the hip and knee that hampers both passive and active
functions. OBJECTIVE: To investigate the efficacy of OnabotulinumtoxinA
injections on this flexor scheme. METHODS: This open-label observational study
included eleven patients who had suffered a unilateral stroke or traumatic brain
injury. All had impairment in the activities of daily living caused by severe hip
and knee flexion. OnabotulinumtoxinA injections of 300-400U (total dose) were
administered to the iliopsoas (iliacus) and knee flexors and, when necessary, to
other muscles of the hip and knee. Evaluations were performed pre-treatment
(weeks -4 to -8, and day 1) and post-treatment (week 10 and week 21): spasticity,
range of motion, limb positioning, passive functions and pain. RESULTS: A modest
improvement in hip and knee extension was observed, as evidenced by the Modified
Ashworth Score and range of passive extension movements. Limb positioning was
also improved. Clear benefits were found on passive functioning, including
toileting, dressing and bed facilities, as well as pain levels. Active functions
remained unchanged. More definite improvement was found in patients with severe
difficulties. CONCLUSIONS: OnabotulinumtoxinA injection can contribute to
reducing the consequences of disabling lower limb flexion.

Langue : ANGLAIS