Correlation between active command disorder and ambulation speed in chronic spastic paresis
Mrs Mouna GHEDIRAa, Ms Maud PRADINESa, Dr Valentina MARDALEa, Dr Catherine Marie LOCHEa, Prof Jean-Michel GRACIESa, Dr Emilie HUTINa
a Laboratoire Analyse et Restauration du Mouvement, EA BIOTN, Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, AP-HP, Université Paris-Est Créteil
Introduction: In spastic paresis, the ambulation impairments are mainly associated with the paresis of agonists and the contracture/cocontraction/spasticity of antagonists.1 The objective is to explore correlation between these neuromuscular mechanisms associated with the deficits of hip, knee and ankle flexion in swing phase and the ambulation speed.
Methods: Twenty one chronic hemiparetic subjects (time since stroke, 8±8years) performed a barefoot 10-meter ambulation test at comfortable (SPcomf) then maximal (SPmax) speed2 and an evaluation of the antagonist resistance3 due to 4 main muscles: soleus, gastronemius, gluteus maximus and rectus femoris. The parameters quantified were: speed ambulation, and for each muscle, the passive range of motion (maximal slow stretch, XV1), the angle of catch at fast stretch (XV3), the active range of motion (A), the frequency of active alternative fast movements in 15s (F15) and the range of the last active movement in 15s (A15). A multivariate correlation analysis was performed between the XV1, XV3, A, F15 and A15 parameters and ambulation speeds.
Results: Comfortable speed 0.61±0.25m/s, fast 0.71±0.29m/s. In distal, ambulation speed was positively correlated with ASoleus (vs SPcomf, r=0.54, p=0.011; SPmax, r=0.47, p=0.032), F15-Soleus (vs SPcomf, r=0.67, p=0.001; SPmax, r=0.71, p<0.0001) and F15-Gastrocnemius (vs SPcomf, r=0.48, p=0.028; SPmax, r=0.40, p=0.071). In proximal, ambulation speed was positively correlated with A15-GluteusMaximus (vs SPcomf, r=0.46, p=0.036; SPmax, r=0.43, p=0.052), and Xv1-RectusFemoris (vs SPcomf, r=0.44, p=0.051; SPmax, r=0.41, p=0.070).
Conclusions: In chronic spastic paresis, the decrease of ambulation speed is correlated with the deficit of ankle dorsiflexion active command associated with the tibialis anterior paresis/triceps surae cocontraction, and with the deficit of the hip flexion active command associated with the hip flexors paresis/gluteus maximus cocontraction and the rectus femoris contracture.
1Gracies JM. Pathophysiology of Spastic Paresis. Muscle Nerve 2005;31:535-71.
2Hutin E, Ghédira M, Loche GM, Mardale V, Gracies JM. Intra and inter-rater reliability of the 10-meter ambulation test. NeuroRehab 2015 (in press).
3Gracies JM, Bayle N, Vinti M, Alkandari S, Vu P, Loche CM, Colas C. Five-step clinical assessment in spastic paresis. Eur J Phys Rehabil Med 2010;46:411-21.
Keywords : Speed ambulation, Paresis, Cocontraction, Active command, Spasticity