Jean‐Michel Gracies

BACKGROUND: Resistance from antagonistic muscle groups might be a crucial factor reducing function in chronic hemiparesis. The resistance due to spastic co-contraction might be reduced by botulinum toxin injections. We assessed the effects of abobotulinumtoxinA injection in the upper limb muscles on muscle tone, spasticity, active movement, and function.

METHODS: In this randomised, placebo-controlled, double-blind study, we enrolled adults (aged 18-80 years) at least 6 months after ...

OBJECTIVE: To demonstrate single abobotulinumtoxinA injection efficacy in lower limb vs placebo for adults with chronic hemiparesis and assess long-term safety and efficacy of repeated injections.

METHODS: In a multicenter, double-blind, randomized, placebo-controlled, single-cycle study followed by a 1-year open-label, multiple-cycle extension, adults ≥6 months after stroke/brain injury received one lower limb injection (abobotulinumtoxinA 1,000 U, abobotulinumtoxinA 1,500 U, placebo) ...

1. The possibility was investigated that the facilitation of the transmission in the propriospinal-like system during voluntary contraction, documented in the companion paper (Burke, Gracies, Mazevet, Meunier & Pierrot-Deseilligny, 1992), is due to a decrease in presynaptic inhibition of afferents projecting to propriospinal-like neurones. 2. The radial nerve was stimulated to evoke presynaptic inhibition of the monosynaptic Ia projections to forearm flexor motoneurones (Berardelli, Day, ...

Spasticity is a velocity-dependent increase in stretch reflex activity. It is one of the forms of muscle overactivity that may affect patients with damage to the central nervous system. Spasticity monitoring is relevant to function because the degree of spasticity may reflect the intensity of other disabling types of muscle overactivity, such as unwanted antagonistic co-contractions, permanent muscle activity in the absence of any stretch or volitional command (spastic dystonia), or ...

OBJECTIVE: To measure the Tardieu Scale's reliability in children with cerebral palsy (CP) when used by raters with and without experience in using the scale, before and after training.

DESIGN: Single-center, intrarater and interrater reliability study.

SETTING: Institutional ambulatory care.

PARTICIPANTS: Referred children with CP in the pretraining phase (n=5), during training (n=3), and in the posttraining phase (n=15).

INTERVENTIONS: The Tardieu Scale involves performing passive ...

OBJECTIVE: To evaluate the reliability of the Ashworth Scale and the Disability Assessment Scale (DAS) in poststroke patients with upper-limb spasticity and functional disability.

DESIGN: Single-center trial.

SETTING: University medical center.

PARTICIPANTS: Nine patients > or = 6 months poststroke with upper-limb spasticity and impairment in the areas of hygiene, dressing, limb posture, or pain were included in the analysis.

INTERVENTIONS: Ten experienced medical professionals rated ...

BACKGROUND: Botulinum toxin (BTX) injection into rectus femoris (RF) is a therapeutic modality used to improve knee flexion during the swing phase of gait in hemiparesis. The impact of this treatment on lower limb coordination is unknown. The authors evaluated whether BTX injection into RF is associated with modifications of intersegmental coordination in hemiparesis.

METHODS: The authors evaluated gait in 10 control and 14 hemiparetic subjects with low peak knee flexion associated with ...

OBJECTIVE: To assess acceptability, effects on swelling, resting posture, spasticity, and active (AROM) and passive range of motion (PROM) of individually tailored upper limb Lycra garments, designed as dynamic splints to exert directional pull on certain limb segments, when worn for 3 hours by hemiplegic patients.

DESIGN: Crossover trial.

SETTING: Outpatient and inpatient rehabilitation center.

PATIENTS: Convenience sample of 16 patients with hemiparesis and upper limb spasticity caused ...

BACKGROUND: While spasticity is commonly treated with oral agents or botulinum neurotoxin (BoNT) injection, these treatments have not been systematically compared.

METHODS: This study performed a randomised, double-blind, placebo-controlled trial to compare injection of BoNT-Type A into spastic upper limb muscles versus oral tizanidine (TZD), or placebo, in 60 subjects with upper-limb spasticity due to stroke or traumatic brain injury (TBI). Wrist flexors were systematically injected, ...

1. The patterns of excitation and convergence by peripheral afferents on propriospinal-like neurones projecting to forearm flexor carpi radialis (FCR) motoneurones in human subjects were determined at rest and during various voluntary contractions, using H reflex testing. 2. At rest, the FCR H reflex could be facilitated by mixed nerve (ulnar, musculocutaneous) and cutaneous (afferents from both sides of the hand) inputs. The characteristics of this facilitation (low threshold, long ...

Systemic pharmacologic treatments may be indicated in conditions in which the distribution of muscle overactivity is diffuse. Antispastic drugs act in the CNS either by suppression of excitation (glutamate) enhancement of inhibition (GABA, glycine), or a combination of the two. Only four drugs are currently approved by the US FDA as antispactic agents: baclofen, diazepam, dantrolene sodium, and tizanidine. However, there are a number of other drugs available with proven antispastic ...

1. The pattern of distribution of non-monosynaptic (propriospinal-like) excitation to various motor nuclei (deltoid, extensors and flexors of the elbow, the wrist and the fingers) was investigated. 2. Changes in the firing probability of individual voluntarily activated motor units were studied following conditioning stimuli. Conditioning volleys were evoked by weak electrical stimuli applied to various mixed nerves (circumflex, musculocutaneous, median, radial, ulnar) and to the skin. ...

This position paper introduces an assessment method using staged calculation of coefficients of impairment in spastic paresis, with its rationale and proposed use. The syndrome of deforming spastic paresis superimposes two disorders around each joint: a neural disorder comprising stretch-sensitive paresis in agonists and antagonist muscle overactivity, and a muscle disorder ("spastic myopathy") combining shortening and loss of extensibility in antagonists. Antagonist muscle overactivity ...

In the subacute and chronic stages of spastic paresis, stretch-sensitive (spastic) muscle overactivity emerges as a third fundamental mechanism of motor impairment, along with paresis and soft tissue contracture. Part II of this review primarily addresses the pathophysiology of the various forms of spastic overactivity. It is argued that muscle contracture is one of the factors that cause excessive responsiveness to stretch, which in turn aggravates contracture. Excessive responsiveness ...

1. The possibility that stimulation of the motor cortex facilitates transmission in the pathway mediating non-monosynaptic ('propriospinal') excitation from low-threshold afferents to upper limb motoneurones was investigated. 2. Convergence between peripheral afferent volleys (from the ulnar or musculo-cutaneous nerve) and corticospinal volleys (evoked by magnetic stimulation of the motor cortex) was investigated using the spatial facilitation technique. Thus the effects of these volleys ...