Nicolas Roche, Raphaël Zory, Antoine Sauthier , Celine Bonnyaud, Didier Pradon, Djamel Bensmail
Services de Physiologie - Explorations Fonctionnelles, Médecine Physique et de Réadaptation et Centre d’Innovation Technologique, Hôpital Raymond Poincaré, AP-HP, Garches, France. E-mail: roche.nicolas@rpc.aphp.fr
DOI: 10.2340/16501977-1887

Background: Botulinum toxin injections are used to treat spasticity in stroke. Although this treatment is effective on muscle tone, its effect on functional gait-related activities remains uncertain.
Objective: The aim of this randomized controlled trial was to determine the effect of a self-rehabilitation programme as an adjunct to botulinum toxin injections on gait-related activities in patients with chronic hemiparesis.
Methods: Thirty-five outpatients were included. Each patient was randomized to 1 of 2 groups: botulinum toxin + standardized self-rehabilitation programme (R group, n = 19) or botulinum toxin alone (C group, n = 16). Each patient was evaluated with the following tests before botulinum toxin injections and one month afterwards: 10-m timed walk, Timed Up and Go, distance covered in 6 min over an ecological circuit, and the stair test.
Results: There were significant improvements in the R group compared with the C group: maximal gait speed improved by 8% (p = 0. 003); distance covered in 6 min over an ecological circuit increased by 7. 1% (p = 0. 01); and time to ascend and to descend a flight of stairs decreased by 9. 8% (p = 0. 003) and 6. 6% (p = 0. 009), respectively. The self-rehabilitation programme was well tolerated and safe.
Conclusion: These results strongly suggest that a standardized self-rehabilitation programme constitutes a useful adjunct to botulinum toxin injections in order to improve gait-related activities.

Appendix S1