{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T03:33:27Z","timestamp":1788492807287,"version":"build-2803163510"},"reference-count":45,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2020,7,31]],"date-time":"2020-07-31T00:00:00Z","timestamp":1596153600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>In stroke survivors, rectus femoris (RF) spasticity is often implicated in gait pattern alterations such as stiff knee gait (SKG). Botulinum toxin type A (BoNT-A) is considered the gold standard for focal spasticity treatment. However\u2014even if the accuracy of injection is crucial for BoNT-A efficacy\u2014instrumented guidance for BoNT-A injection is not routinely applied in clinical settings. In order to investigate the possible implications of an inadequate BoNT-A injection on patients\u2019 clinical outcome, we evaluated the ultrasound-derived RF characteristics (muscle depth, muscle thickness, cross-sectional area and mean echo intensity) in 47 stroke survivors. In our sample, we observed wide variability of RF depth in both hemiparetic and unaffected side of included patients (0.44 and 3.54 cm and between 0.25 and 3.16 cm, respectively). Moreover, our analysis did not show significant differences between treated and non-treated RF in stroke survivors. These results suggest that considering the inter-individual variability in RF muscle depth and thickness, injection guidance should be considered for BoNT-A treatment in order to optimize the clinical outcome of treated patients. In particular, ultrasound guidance may help the clinicians in the long-term follow-up of muscle quality.<\/jats:p>","DOI":"10.3390\/toxins12080490","type":"journal-article","created":{"date-parts":[[2020,8,3]],"date-time":"2020-08-03T07:45:57Z","timestamp":1596440757000},"page":"490","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Rectus Femoris Characteristics in Post Stroke Spasticity: Clinical Implications from Ultrasonographic Evaluation"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0221-7102","authenticated-orcid":false,"given":"Lucia","family":"Cosenza","sequence":"first","affiliation":[{"name":"Physical and Rehabilitation Medicine, Department of Scienze della Salute, University of Piemonte Orientale, 28100 Novara, Italy"},{"name":"Physical and Rehabilitation Medicine, \u201cMaggiore della Carit\u00e0\u201d University Hospital, 28100 Novara, Italy"},{"name":"Rehabilitation Unit, Department of Rehabilitation, \u201cSanti Antonio e Biagio e Cesare Arrigo\u201d National Hospital, 15121 Alessandria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3558-8276","authenticated-orcid":false,"given":"Alessandro","family":"Picelli","sequence":"additional","affiliation":[{"name":"Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8185-5742","authenticated-orcid":false,"given":"Danila","family":"Azzolina","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine, University of Piemonte Orientale, 28100 Novara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8434-0341","authenticated-orcid":false,"given":"Marco Alessandro","family":"Minetto","sequence":"additional","affiliation":[{"name":"Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5141-0681","authenticated-orcid":false,"given":"Marco","family":"Invernizzi","sequence":"additional","affiliation":[{"name":"Physical and Rehabilitation Medicine, Department of Scienze della Salute, University of Piemonte Orientale, 28100 Novara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Bertoni","sequence":"additional","affiliation":[{"name":"Physical Medicine and Rehabilitation, ASST Sette Laghi, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1452-8485","authenticated-orcid":false,"given":"Andrea","family":"Santamato","sequence":"additional","affiliation":[{"name":"Physical Medicine and Rehabilitation Section, \u201cOORR\u201d Hospital, University of Foggia, 71122 Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8440-6283","authenticated-orcid":false,"given":"Alessio","family":"Baricich","sequence":"additional","affiliation":[{"name":"Physical and Rehabilitation Medicine, Department of Scienze della Salute, University of Piemonte Orientale, 28100 Novara, Italy"},{"name":"Physical and Rehabilitation Medicine, \u201cMaggiore della Carit\u00e0\u201d University Hospital, 28100 Novara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,7,31]]},"reference":[{"key":"ref_1","unstructured":"Lance, J. 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