Evaluation of the Predominant Role in Patients with Spastic Equinus Foot after Stroke: A Clinical Study of the Effects of Block of Motor Nerve Branches to the Triceps Surae Muscle
LIU Zhi-Hua;ZHANG Hong-Cui;YU Da-Jun;et al.
2010, 5(04):
291-298.
Asbtract
(
)
PDF (6563KB)
(
)
Related Articles |
Metrics
Objective To evaluate the prominent role of the triceps surae muscle through selective anestheticblocks of motor nerve branches to the triceps surae muscle on lower limb in patients with spasticequinus foot.Methods Thirty patients with stroke were assessed before and after selective anesthetic blockof the superior soleus nerve or the gastrocnemius nerve, which performed by lidocaine injection.Clinical assessments such as SR(stretch reflex), Ashworth scale, rROM(rest range of motion),AROM(active range of motion), PROM(passive range of motion), strength of plantarflexion muscle,walking speed for 10m(at cosy speed and volant speed, separately), cadence, walking distance for3mins, PCI(physical consume index), step length, toe out angle were performed 30mins beforeand after each motor block. The patients were devided into three groups, they were preoperativepostgastrocnemius,preoperative- postsoleus, postgastrocnemius – postsoleus separately. Wecompared differences in these indicators.Results Spasm index such as stretch reflex, Ashworth scale, AROM and PROM were all decreasedin postgastrocnemius, there were statistically differences compared with preoperative, (P all <0.01).Stretch reflex, Ashworth scale, rROM, AROM and PROM were all decreased in postsoleus, (P all<0.01); there were significant differences between two blocks in each of them, they showed thaton SR, AROM and PROM P all <0.01, on Ashworth, rROM P all <0.05; Plantar flexor musclestrength decreased in postgastrocnemius(P <0.01) but not in postsoleus, comparison of two blocksP <0.01; there were no significant differences on walking targets in postgastrocnemius but therewere statistically differences in postsoleus except for walking distance for 3mins compared withpreoperative, on walking speed for 10m at volant speed and cadence P all<0.01, on walking speedfor 10m at cosy speed and PCI P all<0.05.Also there were significant difference between the twoblocks except for walking distance for 3mins, they showed that on walking speed for 10m at cosyspeed P <0.05, other index P all<0.01.There were no significant difference for step length andtoe out angle in the affected side compared with preoperative, also no statistically difference wasobserved between the two blocks in the affected side.Conclusion Both soleus nerve block and gastrocnemius nerve block could alleviate spasticityin patients with spastic equinus foot, but soleus nerve block appeared more appropriate thangastrocnemius nerve block to relieve spasticity clinically, which mainly manifested in people'swalking ability. It constitutes an additional argument in favor of the predominant role of the soleusin spastic foot.
