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Effect of intrathecal baclofen bolus injection on ankle muscle activation during gait in patients with acquired brain injury.
Neurorehabil Neural Repair 2015; 29(2):163-73NN

Abstract

BACKGROUND

Intrathecal baclofen (ITB) bolus injection effectively decreases spinal excitability but the impact on lower limb muscle activation during gait has not been thoroughly investigated.

OBJECTIVE

Examine activation of medial gastrocnemius (MG) and tibialis anterior (TA) muscles during gait before and after ITB bolus injection in patients with resting hypertonia after acquired brain injury.

METHODS

Lower extremity Ashworth score, temporospatial gait parameters, characteristics of the linear relationship between electromyogram (EMG) and lengthening velocity (LV) in MG during stance, and the duration and magnitude of TA-MG coactivation were assessed before and at 2, 4, and 6 hours after a 50-µg ITB injection via lumbar puncture in 8 hemorrhagic stroke and 11 traumatic brain injury subjects.

RESULTS

Temporospatial gait parameters did not significantly differ across the evaluation points (P ≥ .170). However, Ashworth score (P < .001), frequency and gain of significant positive EMG-LV slope (P ≤ .020), and duration of TA-MG coactivation (P ≤ .013) significantly decreased in the more-affected leg after ITB bolus. EMG changes were not significantly different between patients who did (n = 10) and did not (n = 9) increase gait speed after the injection. The timing of the largest decrease in Ashworth score and the largest decrease in EMG parameters coincided in 36% of cases, on average.

CONCLUSIONS

ITB bolus injection alters the activation of MG and TA during gait. However, the changes in muscle activation are not closely related to the changes in gait speed or resting muscle hypertonia. The analysis of ankle muscle activation during gait better characterizes the response to ITB bolus injection than gait kinematics.

Authors+Show Affiliations

Methodist Rehabilitation Center, Jackson, MS, USA jchow@mmrcrehab.org.University of Alberta, Edmonton, Alberta, Canada.Methodist Rehabilitation Center, Jackson, MS, USA.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

24803494

Citation

Chow, John W., et al. "Effect of Intrathecal Baclofen Bolus Injection On Ankle Muscle Activation During Gait in Patients With Acquired Brain Injury." Neurorehabilitation and Neural Repair, vol. 29, no. 2, 2015, pp. 163-73.
Chow JW, Yablon SA, Stokic DS. Effect of intrathecal baclofen bolus injection on ankle muscle activation during gait in patients with acquired brain injury. Neurorehabil Neural Repair. 2015;29(2):163-73.
Chow, J. W., Yablon, S. A., & Stokic, D. S. (2015). Effect of intrathecal baclofen bolus injection on ankle muscle activation during gait in patients with acquired brain injury. Neurorehabilitation and Neural Repair, 29(2), pp. 163-73. doi:10.1177/1545968314533615.
Chow JW, Yablon SA, Stokic DS. Effect of Intrathecal Baclofen Bolus Injection On Ankle Muscle Activation During Gait in Patients With Acquired Brain Injury. Neurorehabil Neural Repair. 2015;29(2):163-73. PubMed PMID: 24803494.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of intrathecal baclofen bolus injection on ankle muscle activation during gait in patients with acquired brain injury. AU - Chow,John W, AU - Yablon,Stuart A, AU - Stokic,Dobrivoje S, Y1 - 2014/05/06/ PY - 2014/5/8/entrez PY - 2014/5/8/pubmed PY - 2015/8/20/medline KW - coactivation KW - hypertonia KW - spasticity KW - stretch reflex KW - stroke KW - traumatic brain injury SP - 163 EP - 73 JF - Neurorehabilitation and neural repair JO - Neurorehabil Neural Repair VL - 29 IS - 2 N2 - BACKGROUND: Intrathecal baclofen (ITB) bolus injection effectively decreases spinal excitability but the impact on lower limb muscle activation during gait has not been thoroughly investigated. OBJECTIVE: Examine activation of medial gastrocnemius (MG) and tibialis anterior (TA) muscles during gait before and after ITB bolus injection in patients with resting hypertonia after acquired brain injury. METHODS: Lower extremity Ashworth score, temporospatial gait parameters, characteristics of the linear relationship between electromyogram (EMG) and lengthening velocity (LV) in MG during stance, and the duration and magnitude of TA-MG coactivation were assessed before and at 2, 4, and 6 hours after a 50-µg ITB injection via lumbar puncture in 8 hemorrhagic stroke and 11 traumatic brain injury subjects. RESULTS: Temporospatial gait parameters did not significantly differ across the evaluation points (P ≥ .170). However, Ashworth score (P < .001), frequency and gain of significant positive EMG-LV slope (P ≤ .020), and duration of TA-MG coactivation (P ≤ .013) significantly decreased in the more-affected leg after ITB bolus. EMG changes were not significantly different between patients who did (n = 10) and did not (n = 9) increase gait speed after the injection. The timing of the largest decrease in Ashworth score and the largest decrease in EMG parameters coincided in 36% of cases, on average. CONCLUSIONS: ITB bolus injection alters the activation of MG and TA during gait. However, the changes in muscle activation are not closely related to the changes in gait speed or resting muscle hypertonia. The analysis of ankle muscle activation during gait better characterizes the response to ITB bolus injection than gait kinematics. SN - 1552-6844 UR - https://www.unboundmedicine.com/medline/citation/24803494/Effect_of_intrathecal_baclofen_bolus_injection_on_ankle_muscle_activation_during_gait_in_patients_with_acquired_brain_injury_ L2 - http://journals.sagepub.com/doi/full/10.1177/1545968314533615?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -