Biomechanical and Neurophysiological Evaluation of the Effect of a Motor Block and an Injection of Botulinum Toxin on the Stiffness of the Paretic Sural Triceps Muscle
Condition: Cerebrovascular Accident
MeSH terms: Stroke
Study type: Interventional

Summary: 
      The research "Biomechanical and neurophysiological evaluation of the effects of a motor block
      and an injection of botulinum toxin on the stiffness of the paretic sural triceps muscle"
      will study the response to passive stretching in the neurological patient presenting spastic
      paresis after a stroke.
    

Detailed description: 
      Following a stroke, patients see their motor function impaired, in particular by the
      establishment of muscular retractions. These affect motor performance of the patients, as for
      example by impairing their walking capabilities and are responsible for long-term orthopedic
      deformities. Muscular structure influencing ankle and foot mobility are particularly
      evaluated in daily practice due to the major impact of muscle retraction on patients'
      mobility.

      During clinical examination, the evaluator searches the presence of the clinical markers of
      muscle retraction. However their clinical evaluation remains subjective and does not always
      allow to identify the precise location (which muscles) and origin (muscle contraction or
      retraction) of the observed response.

      In that case, the sensitive nerve block (BNS)can complete the clinical examination. Its
      efficacy and selectivity are difficult to evaluate in a precise manner by a clinical
      examination on its own. Moreover, the possibility to predict the effect of a long-lasting
      spasticity treatment, like a botulinum toxin injection (ITB), from the effect of a BNS, has
      not been proven on the sural triceps muscle.

      The study will use several evaluation techniques by biomechanical, neurophysiological and
      ultrasound (elastography) study which allow to quantify the response level within a muscle
      (measure of the muscle stiffness and retraction).

      This study will take place within the rehabilitation and physical medicine department,
      patients are hospitalized or seen during stroke follow-up examination for uncomfortable sural
      triceps spasticity. They are evaluated by a quantified walking test, followed by a BNS, if
      the BNS result is positive, they are treated by a botulinum toxin injection in the sural
      triceps. The stiffness measurements before BNS (J0), after BNS (J0 post BNS) and after ITB
      (at day 28) will be standardized and additional instrumental examinations will be realized to
      understand the effects of the BNS and ITB procedure. The stretching will be performed by an
      isokinetic dynamometer and the muscle response to the stretching will be achieved by
      simultaneous evaluation of the response of the leg muscles by elastography and
      electromyography. In addition, clinical and neurophysiological data (exploration of nerve
      conduction on the tibial nerve) will be measured
    

Intervention name(s): Selective nerve block
Intervention type(s): Other
Intervention description(s): D0 :
Information, collection of consent, inclusion,
Clinical and instrumental evaluation,
Realization of the selective nerve block,
Post-selective nerve block clinical and instrumental re-evaluation,
Performance of the botulinum toxin injection if indication selected.
D28 (+/-5 days) :
- Clinical and instrumental post-botulinum toxin injection evaluation.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Other