Improves walking stability and speed
Botox treatment to reduce spasm in the hip adductor muscle group followed by stretching resulted in increased walking speed and a wider base width that increased stability. The ability to quickly step sideways to regain balance was also improved.
Spasticity in the hip adductor muscles commonly occurs with HSP. The hip adductor muscles are a group of muscles in the groin and inner thigh area. With spasticity, they pull the leg more towards, or even across, the centre line when walking. This results in a narrow base of support, almost like walking a tightrope, thus increasing instability and the challenge to balance.
Patients with pure hereditary spastic paraplegia often have hip adductor spasticity, causing reduced base width and a narrow base of support. In addition, they experience difficulties stepping sideways to recover from sideward balance perturbations. A narrow base of support and the presumed side-stepping difficulties probably increase their risk of falling.
Botulinum toxin type A injections are commonly used to reduce spasticity in patients with hereditary spastic paraplegia, but no studies have systematically investigated the effects of botulinum toxin type A in (with subsequent stretching of) the hip adductors on gait and balance.
The results of this study indicate that, after botulinum toxin type A administration, there is an increase in comfortable gait speed and base width. Furthermore, patients show improved reactive stepping responses when the perturbation direction is known.
It is concluded that botulinum toxin type A treatment and subsequent stretching of the hip adductors may improve gait and reactive lateral stepping in patients with pure hereditary spastic paraplegia.
SOURCE: Journal of Rehabilitation Medicine DOI: 10.2340/16501977-2556
Functional effects of botulinum toxin type A in the hip adductors and subsequent stretching in patients with hereditary spastic paraplegia
Bas J.H. van Lith, Jasper den Boer, Bart P.C. van de Warrenburg, Vivian Weerdesteyn, Alexander C. Geurts
Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, 6541GX Nijmegen, The Netherlands.