Comparative shortening of different muscles in patients with chronic hemiparesis treated in guided self-rehabilitation contracts.
Mr Blaise BIGNAMIa, Ms Marjolaine BAUDEa, Mr Jordan VIELOTTEa, Dr Catherine-Marie LOCHEa, Dr Caroline COLASa, Mr Maud PRADINESa, Prof Jean-Michel GRACIESa
a Fédération de neurorééducation, Hôpital Albert Chenevier, Créteil
Objectives. Muscle contracture is one of the main factors of motor impairment in spastic paresis, and particularly in hemiparesis. We aimed to quantify the degree of contracture in 8 key muscles at a chronic stage after the lesion.
Methods. Four independent raters assessed 18 adults with chronic hemiparesis (age 50±14, mean±SD; time since lesion 5.3±2.4 years) treated with Guided Self-rehabilitation Contracts(1) (GSC), using the 5-Step Clinical Assessment(2) previously described, of which Step 2 evaluates passive range of motion (angle of arrest at slow speed, XV1) and Step 3 measures the angle of catch at fast speed (XV3). Data from the 4 investigators were averaged. Coefficients of shortening (CSH = (XN-XV1)/XN; XN, normal expected amplitude) and of spasticity (CSP = (XV1-XV3)/XV1) were derived. Muscles assessed were shoulder extensors (SE), elbow flexors (EF), wrist flexors (WF), finger flexors (FF), gluteus maximus (GM), rectus femoris (RF), soleus (SO) and gastrocnemius muscles (GM).
Results. Mean values were: SE, CSH, 0.21±0.03; CSP, 0.25±0.03; EF, CSH, 0.04±0.02, CSP, 0.27±0.04; WF, CSH, 0.07±0.02, CSP, 0.24±0.04; FF, CSH, 0.16±0.04, CSP 0.32±0.04; GM, CSH, 0.16±0.03, CSP, 0.13±0.02; RF, CSH, 0.09±0.01, CSP, 0.26±0.03; SO, CSH, 0.15±0.02, CSP, 0.10±0.01; GM, CSH, 0.21±0.01, CSP, 0.12±0.01. There was a suggestion of negative correlation between CSH and CSP (Pearson’s r=-0.37, NS).
Conclusion. In chronic hemiparesis, plantar flexors and shoulder extensors are the most shortened muscles, followed by gluteus maximus and finger flexors. This might represent an incentive to promote more aggressive posturing in the acute stages to maintain length of these important muscle groups.
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- Gracies JM, Bayle N, Vinti M, Alkandari S, Vu P, Loche CM, Colas C. Five-step clinical assessment in spastic paresis. Eur J Phys Rehab Med. 2010;46(3):411-21.
Keywords : Muscle contracture, chronic hemiparesis, self-rehabilitation