Changes in walking performance in the chronic phase of stroke recovery using botulinum toxin, physiotherapy and orthotic management: Three longitudinal case studies

Ms Janine Simondson1, Mr Robert Mehan1, Ms Diana  Poole2, Dr  Kim Brock1

1Physiotherapy Department St Vincent’s Hospital Melbourne, , Australia

2Prosthetics and Orthotic Department St Vincent’s Hospital Melbourne, , Australia


Aim: The aims will be to determine the long term change in walking performance and function over time with the combination of treatment for spasticity with Botulinum Toxin (BTX), physiotherapy and orthotic management in patients who are over 6 months post stroke.


Method: Stroke survivors were recruited via a BTX clinic. Participants who consented had 18 months of therapy documented, including physiotherapy, orthotic and pharmacological management. Objective gait measures were recorded at baseline, two, four, six, eight, twelve and eighteen months post initial management. Gait measures recorded were velocity, affected limb step length (ALSL) and single support (ALSS) walking in three walking conditions: barefoot, shod and shod with prescribed orthoses (“bracing”).


Results: Three participants have completed all assessments. Patient A’s velocity improved over the three walking conditions; however ALSL and ALSS were equivocal.  Patient B’s velocity, ALSL and ALSS improved walking in shoes and bracing but not barefoot. Patient C’s walking velocity, ALSL and ALSS improved between baseline and eight months walking in the bracing condition. There was deterioration in walking performance between eight and 18 months. Each participant received BTX and physiotherapy (treatment techniques/gait retraining) and orthotic management (serial casting/orthotic prescription and modification). Patient C fell at 10 months; resulting in pain and loss of confidence which may have caused their deterioration in walking.


Significance of findings to allied health: Walking performance can be improved with an individualised multidisciplinary approach. Chronic stroke survivors perform differently under different walking conditions. Deteriorations in walking performance may be attributable to adverse events.