Intrathecal baclofen in subjects with spastic hemiplegia: assessment of the antispastic effect during gait1 Olivier Rémy-Néris, MD, PhD, Vincent Tiffreau,

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Presentation transcript:

Intrathecal baclofen in subjects with spastic hemiplegia: assessment of the antispastic effect during gait1 Olivier Rémy-Néris, MD, PhD, Vincent Tiffreau, MD,, Stéphane Bouilland, MD, Bernard Bussel, MD Archives of Physical Medicine and Rehabilitation Volume 84, Issue 5, Pages 643-650 (May 2003) DOI: 10.1016/S0003-9993(02)04906-7

Fig 1 Gait characteristics of S3 before baclofen. (A) Changes in the ankle joint angle (solid line) and Fz (dotted line) during walking. The time period (arrow in both graphs) is the beginning of the gait cycle just after the heel strike that corresponds to stretching of the triceps. (B) The ankle moment increased regularly. Fz and the ankle moment are expressed as a percentage of the body weight (% BW). The gait cycle is normalized (100%). Archives of Physical Medicine and Rehabilitation 2003 84, 643-650DOI: (10.1016/S0003-9993(02)04906-7)

Fig 2 Gait characteristics of S1 before baclofen. (A) Changes in the knee joint angle (solid line) and Fz (dotted line) during a gait cycle. The period (arrow in both graphs) is the end of the loading time of the gait cycle just before toe off. (B) The knee moment decreased during knee flexion in this subject. Fz and the knee moment are expressed as a percentage of the body weight (% BW). The gait cycle is normalized (100%). Archives of Physical Medicine and Rehabilitation 2003 84, 643-650DOI: (10.1016/S0003-9993(02)04906-7)

Fig 3 Ankle dorsiflexion (A) before (dotted line) and after (solid line) ITB at preferred walking speed in S3. The initial plantarflexion is restored. The maximal dorsiflexion is unchanged after ITB. (B) The slope of the moment-angle correlation is reduced. Archives of Physical Medicine and Rehabilitation 2003 84, 643-650DOI: (10.1016/S0003-9993(02)04906-7)

Fig 4 Ankle flexion and electromyographic activity of the soleus and tibialis anterior (A) before ITB and (B) after ITB in S1 during a gait cycle. Abbreviation: HS, heel strike. Archives of Physical Medicine and Rehabilitation 2003 84, 643-650DOI: (10.1016/S0003-9993(02)04906-7)

Fig 5 Mean moment-angle curves of the knee during knee flexion (see fig 2) in 4 hemiplegic subjects with a knee flexion more than 20° during the swing phase before ITB (dashed lines) and after ITB (solid lines). Joint moments are expressed as a percentage of the body weight (% BW). Archives of Physical Medicine and Rehabilitation 2003 84, 643-650DOI: (10.1016/S0003-9993(02)04906-7)

Fig 6 The patterns of vastus lateralis and biceps femoris activation (A) before ITB and (B) after ITB in S1. The biceps femoris was activated throughout the stance phase until the initial flexion of the knee before ITB and not after ITB. The vastus lateralis activation during knee flexion decreased after ITB. The gait cycle is expressed in arbitrary units (AU). Archives of Physical Medicine and Rehabilitation 2003 84, 643-650DOI: (10.1016/S0003-9993(02)04906-7)