Walking assessment with instrumented insoles in patients with lower limb spasticity after botulinum toxin infiltration.

INTRODUCTION: Botulinum toxin A (BTA) improves the kinematic parameters of gait in patients with spasticity of lower limbs, but there are no studies in which kinetic parameters are measured with instrumented insoles. We therefore used instrumented insoles to perform a functional assessment of therapeutic results in patients with lower limb spasticity after brain injury or spinal cord infiltration indicating BTA. MATERIAL AND METHODS: Ten patients (11 lower limbs) seen in a Neurorehabilitation Unit. The tests carried out included clinical examination, gait assessment (Functional Ambulation Categories (FAC); Hospital de Sagunto Gait Scale), and biomechanical assessment (Biofoot / IBV version 5.0), before and three weeks after infiltration with BTA. STATISTICS: t-test for related samples of clinical variables, functional variables and biomechanical variables before and after infiltration. Level of significance P< .05. Qualitative method to assess whether changes in the biomechanical variables tended toward normal values. RESULTS: BTA improves muscle tone, joint arch and frequency of spasms (P<.01). The patient sample showed a high level of satisfaction with the improvement in symptoms. There were no changes in walking ability after injection. There were no statistically significant changes in biomechanical parameters, but there was improved gait cadence. The relatively small statistical significance close to P=.1 of the peak pressure in the heel after injection indicates the need for further studies with instrumented insoles in people with spasticity due to central nervous system injury. CONCLUSIONS: With the decrease in muscle tone after infiltration with BTA the clinical symptoms associated with muscle tone improved without any functional changes in gait scales. The changes in the biomechanical parameters show that larger studies using instrumented insoles should be performed in the population with spasticity after a central nervous system injury treated with BTA infiltration.

Clinical effectiveness of grip strength in predicting ambulation of elderly inpatients.

BACKGROUND: Assessing the clinical effectiveness of measuring grip strength as a prognostic tool in recovering ambulation in bed-confined frail elderly patients. METHODS: A prospective study was carried out with 50 elderly inpatients (mean age: 81.6 years old). Manual muscle test was used for checking strength of hip flexor muscles, hip abductor muscles and knee extensor muscles. Grip strength was assessed by hydraulic dynamometer. Walking ability was assessed by functional ambulation categories and Functional Classification of Sagunto Hospital Ambulation. Existence of cognitive impairment (Short Portable Mental Status of Pfeiffer) and comorbidity (abbreviated Charlson index) were considered to be confounding variables. STATISTICAL ANALYSIS: Simple comparisons and mixed models of multiple ordinal regression. RESULTS: The sample presented generalized weakness in scapular (mean 4.22) and pelvic (mean 3.82) muscle. Mean hand grip values were similar: 11.98 kg right hand; 11.70 kg left hand. The patients had lost walking ability. After treatment, there was a statistically significant for scapular waist strength (P=0.001), pelvic waist strength (P=0.005) and walking ability (P=0.001). A statistically significant relationship in the regression analysis was found between the grip (right and left hands) and walking ability post-treatment (P=0.009; odds ratio 1.14 and P=0.0014 odds ratio 1.113 for each walking scale). The confounding variables showed no statistical significance in the results. CONCLUSION: Grip strength is associated with walking ability in hospitalized frail elderly. Grip strength assessment by hydraulic dynamometry is useful in patients with poor collaboration. Walking ability training in frail elderly inpatients is useful.

Valoración de la marcha mediante plantillas instrumentadas en pacientes con espasticidad de miembros inferiores tras infiltración con toxina botulínica / Walking assessment with instrumented insoles in patients with lower limb spasticity after botulinum toxin infiltration

Introducción: El objetivo del presente trabajo es la valoración funcional y cinemática en pacientes con espasticidad de miembros inferiores tras lesión encefálica o medular con indicación de infiltración con toxina botulínica (TBA). Material y métodos: Diez pacientes (11 extremidades inferiores) atendidos en unidad de neurorrehabilitación. Examen clínico, funcional (functional ambulation categories, valoración marcha del Hospital de Sagunto) y biomecánico (plantillas instrumentadas Biofoot/IBV versión 5,0) antes y 3 semanas después de la infiltración con TBA. Estadísticos: prueba de la t para muestras relacionadas de las variables clínicas, funcionales y biomecánicas antes y después dela infiltración. Nivel de significación inferior a 0,05. Modo cualitativo para valorar si los cambios en las variables biomecánicas orientan a una aproximación a los parámetros de normalidad. Resultados: La infiltración con TBA mejora el tono muscular, el arco articular y la frecuencia de espasmos (p < 0,01). La población infiltrada muestra un nivel alto de satisfacción con la mejora de los síntomas. No hay cambios funcionales en habilidad para la marcha tras la infiltración. En los parámetros biomecánicos mejora de la cadencia de marcha y la presión máxima en retropié se aproxima a la significación estadística cercana a 0,1. Conclusiones: Con la disminución del tono muscular tras infiltración con TBA, mejoran los síntomas clínicos derivados de esta sin cambios funcionales en escalas de marcha. Los cambios en los parámetros biomecánicos indican la necesidad de ampliar los estudios con plantillas instrumentadas en población con espasticidad tras lesión del sistema nervioso central tratada con infiltración de TBA (AU)

Introduction: Botulinum toxin A (BTA) improves the kinematic parameters of gait in patients with spasticity of lower limbs, but there are no studies in which kinetic parameters are measured with instrumented insoles. We therefore used instrumented insoles to perform a functional assessment of therapeutic results in patients with lower limb spasticity after brain injury or spinal cord infiltration indicating BTA. Material and methods: Ten patients (11 lower limbs) seen in a Neurorehabilitation Unit. The tests carried out included clinical examination, gait assessment (Functional Ambulation Categories (FAC); Hospital de Sagunto Gait Scale), and biomechanical assessment (Biofoot / IBV version 5.0), before and three weeks after infiltration with BTA. Statistics: t-test for related samples of clinical variables, functional variables and biomechanical variables before and after infiltration. Level of significance P< .05. Qualitative method to assess whether changes in the biomechanical variables tended toward normal values. Results: BTA improves muscle tone, joint arch and frequency of spasms (P<.01). The patient sample showed a high level of satisfaction with the improvement in symptoms. There were no changes in walking ability after injection. There were no statistically significant changes inbiomechanical parameters, but there was improved gait cadence. The relatively small statistical significance close to P=.1 of the peak pressure in the heel after injection indicates the need for further studies with instrumented insoles in people with spasticity due to central nervous system injury. Conclusions: With the decrease in muscle tone after infiltration with BTA the clinical symptoms associated with muscle tone improved without any functional changes in gait scales. The changes in the biomechanical parameters show that larger studies using instrumented insoles should be performed in the population with spasticity after a central nervous system injury treated with BTA infiltration (AU)

Tratamiento mediante iontoforesis de un caso de ciatalgia por fibrosis glútea / Treatment by iontophoresis in a case of sciatalgia due to gluteal fibrosis

Se presenta el caso clínico de una mujer de 72 años remitida al Servicio de Rehabilitación para tratamiento de ciatalgia secundaria a fibrosis reactiva tras inyección glútea. El examen clínico evidenció una lesión indurada en zona glútea izquierda parcialmente adherida a planos profundos cuya presión desencadenaba dolor irradiado por el trayecto correspondiente al nervio ciático. Aportaba estudio ecográfico de la zona cuya descripción morfológica correspondía a una posible fibrosis reactiva. Se optó como medida terapéutica por el empleo de sustancias fibrinolíticas administradas mediante iontoforesis en sesión diaria: 100 Unidades Turbidométricas en 2 ml de suero fisiológico en polo negativo, 0,1 mA/cm2, tiempo de aplicación: 10 minutos. Aparato: Endomed 581 ID. La respuesta fue favorable desde el punto de vista clínico con la remisión del dolor irradiado que se correlacionó con el control ecográfico donde se evidenció la desaparición de la lesión previa. Se contrastan con la literatura las causas de afectación del nervio ciático y se discute la utilidad de emplear sustancias fibrinolíticas aplicadas mediante iontoforesis para tratar lesiones que se caractericen por hipertrofia del tejido conjuntivo. (AU)