Boudarham et al., (2014)

- 18 hemiplegic patients;

- Time since onset: 62.6 ± 31.2 month.

- Over 18 years old;

- More than 6 months post stroke (chronic-phase);

- Score ≥ 1+ on modified Ashworth scale (MAS) for the quadriceps muscles;

- Ability to walk 10 m without walking aids;

- No use of antispastic medications for 6 months before inclusion;

- No orthopedic surgery in the last 6 months.

-Isokinetic dynamometer

Model: ConTrex-MJ, Contrex, CMV AG, Dübendorf, Switzerland;

-EMG.

- Passive range of motion performed: the passive range of the patient is used without pain induction;

- Angular velocities of passive movement: 90, 180 and 240˚/s, randomly;

- Subject position: seated in the chair of the isokinetic dynamometer in a position of 85 hip flexion and the lower legs hanging over the edge of the seat. Lower leg fixed 3 cm above the lateral malleolus;

- Instructions to subjects: subjects were instructed to relax during the trials and to close their eyes;

- Number of repetitions: 5 continuous passive movements of knee flexion;

- Spasticity measurement: - Maximum peak torque resistance for each reflex contraction was determined by the lowest value on the torque curve. - Work calculated in joules by adding the area under the torque curve.

Peak resistive torque during the passive movements at each velocity was not modified by the fatigue protocol, neither was the work slope. Normalized root mean square (RMS) values of the rectus femoris (RF) and vastus lateralis (VL) muscles during passive trials were also similar before and after the fatigue protocol.

Hameau et al., (2014)

- 14 patients with chronic spastic hemiparesis after stroke (12 with right hemiparesis and 2 with left hemiparesis);

- Time since stroke: 90 ± 36 months.

- Over 18 years old;

-Hemiparesis following stroke for more than 6 months;

- Score ≥ 1 on the MAS for the quadriceps muscle;

- Inappropriate RF EMG activity during mid-swing phase of the gait cycle;

- Able to walk 10 m without supportive devices;

- Last BoNT-A injection more than 4 months before inclusion;

- No surgical interventions in the lower limb in the last 6 months.

-Duncan Ely Test;

-Modified Ashworth Scale (MAS);

-Isokinetic dynamometer

Model: ConTrex AG, Dübendorf, Switzerland.

- Passive range of motion performed: 70˚ (from 20˚ to 90˚ knee flexion);

- Angular velocities of passive movement: 10, 90, 180 and 240˚/s (1 minute rest after each speed);

- Subject position: subjects were seated on the dynamometer chair with the back support inclined 15˚ posterior to the vertical plane. Distal fixation 2 centimeters proximal to the lateral malleolus;

- Instructions to subjects: n.d.;

- Number of repetitions: 5 continuous passive movements of knee flexion;

- Spasticity measurement: Incline of the torque - speed curve. Peak resistive torque defined as the maximum resistance force generated during the test, averaging the 5 tests.

The MAS score of the RF decreased significantly after botulinum toxin injection (BoNT-A) (P = 0.027).

Peak resistive torque was significantly decreased at the three tested velocities after BoNT-A injection (90˚/s: P = 0.007; 180˚/s: P = 0.035 and 240˚/s: P = 0.023).