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.