Effect of Botulinum Toxin Injection in the Rectus Femoris on Stiff-Knee Gait in People With Stroke: A Prospective Observational Study
Abstract
Stoquart GG, Detrembleur C, Palumbo S, Deltombe T, Lejeune TM. Effect of botulinum toxin injection in the rectus femoris on stiff-knee gait in people with stroke: a prospective observational study.
Objective
To study the effect of botulinum toxin type A (BTX-A) injection in the rectus femoris on the decreased knee flexion during the swing phase of gait (stiff-knee gait) in people with stroke.
Design
Intervention study (before-after trial) with an observational design.
Setting
Outpatient rehabilitation clinic and gait laboratory.
Participants
Nineteen chronic hemiparetic adults presenting with stiff-knee gait.
Intervention
Injection of 200U of BTX-A (Botox) into the rectus femoris.
Main Outcome Measures
Before and 2 months after BTX-A rectus femoris injection: Stroke Impairment Assessment Set (SIAS), Duncan-Ely test, and an instrumented gait analysis.
Results
Median SIAS score improved from 53 (range, 36−65) to 57 (range, 42−70) (signed-rank test, P=.005) and the Duncan-Ely score from 3 (range, 1−3) to 1 (range, 0−3) (P<.001). In gait analysis, mean (± standard deviation) maximum knee flexion improved from 26°±13° to 31°±14° during the swing phase (paired t test, P<.001), knee flexion speed at toe-off improved from 82°±63° to 112°±75°/s (P=.009), and knee negative joint power (eccentric muscular contraction) improved from −.27±.23 to −.37±.26W/kg (P<.001). The 4 patients who almost did not flex the knee (<10°) before the BTX-A rectus femoris injection did not improve after the injection. The other 14 patients who flexed the knee more than 10° before the BTX-A rectus femoris injection decreased the walking energy cost from 5.4±1.6 to 4.6±1.3J·kg−1·m−1 (P=.006).
Conclusions
BTX-A rectus femoris injection may be beneficial in patients with a stiff-knee gait after stroke, particularly in patients with some knee flexion (>10°).
aRehabilitation and Physical Medicine Unit, Université Catholique de Louvain, Brussels, Belgium
bDepartment of Physical Medicine and Rehabilitation, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
cDepartment of Physical Medicine and Rehabilitation, Université Catholique de Louvain, Cliniques Universitaires de Mont-Godinne, Yvoir, Belgium.
Reprint requests to Thierry M. Lejeune, MD, PhD, Dept of Physical Medicine and Rehabilitation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Ave Hippocrate 10, B-1200 Brussels, Belgium
Supported by the Association Nationale d’Aide aux personnes Handicapées (ANAH-Rotary Belgium and Luxemburg), the Fondation du Patrimoine (Université Catholique de Louvain, Brussels), the Fonds National de la Recherche Scientifique, and the Fonds Spécial de Recherche. Botulinum toxin type A (Botox) was provided by Allergan.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.
ABSTRACT