Maud Pradines

BackgroundAt the onset of stroke-induced hemiparesis, muscle tissue is normal and motoneurones are not overactive. Muscle contracture and motoneuronal overactivity then develop. Motor command impairments are classically attributed to the neurological lesion, but the role played by muscle changes has not been investigated.MethodsInteraction between muscle and command disorders was explored using quantified clinical methodology—the Five Step Assessment. Six key muscles of each of the lower and upper limbs in adults with chronic poststroke hemiparesis were examined by a single investigator, measuring the angle of arrest with slow muscle stretch (XV1) and the maximal active range of motion against the resistance of the tested muscle (XA). The coefficient of shortening CSH= (XN-XV1)/XN(XN, normally expected amplitude) and of weakness CW= (XV1-XA)/XV1) were calculated to estimate the muscle and command disorders, respectively. Composite CSH(CCSH) and CW(CCW) were then derived for each lim...

Supplemental material, Supplemental_Materials for Ultrasound Structural Changes in Triceps Surae After a 1-Year Daily Self-stretch Program: A Prospective Randomized Controlled Trial in Chronic Hemiparesis by Maud Pradines, Mouna Ghedira, Raphaël Portero, Ingrid Masson, Christina Marciniak, Dawn Hicklin, Emilie Hutin, Pierre Portero, Jean-Michel Gracies and Nicolas Bayle in Neurorehabilitation and Neural Repair

Introduction. The effects of long-term stretching (>6 months) in hemiparesis are unknown. This prospective, randomized, single-blind controlled trial compared changes in architectural and clinical parameters in plantar flexors of individuals with chronic hemiparesis following a 1-year guided self-stretch program, compared with conventional rehabilitation alone. Methods. Adults with chronic stroke-induced hemiparesis (time since lesion >1 year) were randomized into 1 of 2, 1-year rehabilitation programs: conventional therapy (CONV) supplemented with the Guided Self-rehabilitation Contract (GSC) program, or CONV alone. In the GSC group, specific lower limb muscles, including plantar flexors, were identified for a diary-based treatment utilizing daily, high-load, home self-stretching. Blinded assessments included (1) ultrasonographic measurements of soleus and medial gastrocnemius (MG) fascicle length and thickness, with change in soleus fascicle length as primary outcome; (2) ma...

Background: In spastic paresis, the respective contributions to active function of antagonist hypoextensibility, spasticity, and impaired descending command remain unknown. Objectives: We explored correlations between ambulation speed and coefficients of shortening, spasticity and, weakness for three lower limb extensors.Methods: This retrospective study identified 140 subjects with chronic hemiparesis (>6 months since injury) assessed during a single visit with barefoot 10-meter ambulation at comfortable and fast speed, and measurements of passive range of motion (XV1), angle of catch at fast stretch (XV3) and active range of motion (XA) against the resistance of gastrocnemius, rectus femoris, and gluteus maximus. Coefficients of shortening (CSH=[XN-XV1]/XN; XN, normal expected amplitude based on anatomical values), spasticity (CSP=[XV1-XV3]/XV1), and weakness (CWK=[XV1-XA]/XV1) were derived. For each muscle, multivariable analysis explored CSH, CSP, and CWK as potential predictors of ambulation speed.Results: Ambulation speed was 0.62±0.28m/s (mean±SD, comfortable) and 0.84±0.38m/s (fast) and was correlated with CSH and CWK against gastrocnemius (CSH, comfortable, ns; fast, β=-0.20, p=.03; CWK, comfortable, β=-0.21, p=.010; fast, β=-0.21, p =.012), rectus femoris (CSH, comfortable, β=-0.41, p=6E-7; fast, β=-0.43, p=5E-7; CWK, comfortable, β=-0.36, p=5E-5; fast, β=-0.33, p=.0003) and gluteus maximus (CSH, comfortable, β=-0.19, p=.02; fast, β=-0.26, p=.002; CWK, comfortable, β=-0.26, p=.002; fast, β=-0.22, p=.010). Ambulation speed was not correlated with CSP.Conclusions: In chronic hemiparesis, ambulation speed correlates with coefficients of shortening and of weakness in lower limb extensors, but not with their spasticity level. This may encourage therapists to focus treatment primarily on muscle shortening by stretching programs and on impaired descending command by active training.