There are two primary effects to these procedures. One is the muscle that is being targeted has it's direct and immediate effect and the other is a more global effect of relaxing the entire limb or even relaxing the entire hemiplegic body to some degree. For example, when we undertake a tibial neurotomy to straighten the foot out and cause that the heel to land on the ground when the patient is walking, they'll often also experienced some relaxation of the proximal muscles. The leg swings easier, they can stand from a chair easier and they have less difficulty walking than they did previously from the proximal aspect, not just the distal aspect. Because of this, we like to undertake these procedures in a stepwise fashion. We will do the most egregious or the most troublesome muscle group first and then look at the global effect that it's accomplished over the next three to six months. Once the patient is plateaued in their recovery. Once again, we'll move on to the second step or the second most problematic muscle group and repeat the same process. Because of this, a patient may undergo four to six procedures before we've completed accomplishing everything we can with our functional recovery.
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