ANTISPASTIC POSITIONING 4 SPASTICITY

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EFFECT OF ANTISPASTIC POSITIONING (NON-WEIGHTBEARING) ON SPASTICITY IN PATIENTS WITH SPINAL CORD INJURIES. : 

8/27/2009 1 EFFECT OF ANTISPASTIC POSITIONING (NON-WEIGHTBEARING) ON SPASTICITY IN PATIENTS WITH SPINAL CORD INJURIES.

BUCH VYOMA N2ND YR. M. PHYSIO STUDENTGOVT. PHYSIOTHERAPY COLLEGEAHMEDABADGUJARAT : 

8/27/2009 2 BUCH VYOMA N2ND YR. M. PHYSIO STUDENTGOVT. PHYSIOTHERAPY COLLEGEAHMEDABADGUJARAT UNDER THE GUIDANCE OF : DR. MAYA J CHAUHAN

INTRODUCTION : 

8/27/2009 3 INTRODUCTION SPASTICITY : Spasticity is an upper motor neuron disorder characterized by velocity dependent increase in muscle tone, with exaggerated tendon jerks resulting from hyperexcitability of stretch reflexes. (SUSAN B. O’ SULLIVAN) ANTISPASTIC POSITION : Positions adopted in reverse to the spastic muscles are termed as antispastic positions. CONVENTIONAL Rx : Includes medical management, physiotherapy exs. like: ●tilt-table management ● stretching, strengthening ● functional re-education program ● balance training, gait training etc. (SUSAN B. O’ SULLIVAN)

OBJECTIVES : 

8/27/2009 4 OBJECTIVES (1) To find out the efficacy of ANTISPASTIC POSITIONING (NWB) on spasticity in patients with spinal cord injuries along with conventional Rx. (2) To study the effect of ANTISPASTIC POSITIONING (NWB) on spasticity in SCI patients.

METHODS : 

8/27/2009 5 METHODS MATERIALS : ●Pillows ●Bedsheets ●Sandbags ●Foot rest of the bed SUBJECTS : Study was conducted at PARAPLEGIA HOSPITAL, CIVIL HOSPITAL, AHMEDABAD. : Patients were divided into 2 groups Grp A & Grp B with 20 patients in each grp, between the age of 20-60 yrs. (40.07±13.99)

METHODS (Contd.) : 

METHODS (Contd.) INCLUSION CRITERIAS : ● Spastic SCI patients with Modified Ashworth Scale (MAS) 3 and less than 3. ● Willing to participate. ● Lowerlimb muscles taken are hip extensors, hip adductors, knee extensors/flexors and ankle plantarflexors. ●Varied grades of ASIA impairment scale. EXCLUSION CRITERIAS : ● Spastic SCI patients with MAS 4. ● Spinal tumours ● Unconscious patients ● Behavioural problems.

PROCEDURE : 

8/27/2009 7 PROCEDURE ● Explanation regarding the objective of the study and its method were taught and consent taken. ●Both the grps were evaluated with MAS prior to Rx and then weekly till the end of 1 month. ●Grp A was given antispastic positioning (NWB) for 1 month along with conventional Rx. ●Grp B was given conventional Rx alone for 1 month

HIP ADDUCTORS& KNEE FLEXORS : 

8/27/2009 8 HIP ADDUCTORS& KNEE FLEXORS HIP EXTENSORS & KNEE EXTENSORS

ANKLE PLANTARFLEXORS : 

8/27/2009 9 ANKLE PLANTARFLEXORS

ANTISPASTIC POSITIONING : 

ANTISPASTIC POSITIONING ●Lowerlimb muscles taken into the study were © HIP EXTENSORS © HIP ADDUCTORS © KNEE EXTENSORS/FLEXORS © ANKLE PLANTAR FLEXORS. ●The antispastic position given was : © HIP IN ABDUCTION © KNEE EXTENDED OR FLEXED (according to muscles involved) © ANKLE IN NEUTRAL POSITION.

Slide 11: 

8/27/2009 11 ●The positioning was given for 20-25 minutes, twice in a day for a period of 1 month. (PEDIATRICS INTERNATIONAL- AUG2005,47, 440-445) ●The same physiotherapist graded the spasticity before and after giving antispastic positioning for improving intrarater reliability. (Blackburn M, van Vliet P, Mockett SP. Reliability of measurements obtained with the Modified Ashworth scale in the lower extremities of people with stroke. Phys Ther 2002; 82: 25–34).

RESULTS : 

8/27/2009 12 RESULTS ●There was highly significant reduction in spasticity in patients treated with ANTISPASTIC POSITIONING (NWB) along with conventional Rx than treated with conventional treatment alone. (For statistical analysis 1+ is equated to 1.5) ●For Grp A: Hip Flexion Movt. t19=6 (p<0.001) Hip Abduction Movt. t19= 6.7 (p<0.001) Knee Movt. t19= 7.22 (p<0.001) Ankle Dorsiflx Movt. t19=7.2 (p<0.001) ●For Grp B: Hip Flexion Movt. t19=0.221 (p<0.1) Hip Abduction Movt. t19= 1.56 (p<0.1) Knee Movt. t19=1.483 (p<0.1) Ankle Dorsiflx Movt. t19=1.086 (p<0.1)

RESULTS (Contd.) : 

8/27/2009 13 RESULTS (Contd.) ●Combining Grp A & Grp B, and applying Z-test the values were: Hip Flexion Movt. Z=3.88 (p<0.01) Hip Abduction Movt. Z= 4.96 (p<0.01) Knee Movt. Z=4.59 (p<0.01) Ankle Dorsiflx Movt. Z=4.64 (p<0.01) ● The Z-values are highly significant, which suggests that antispastic positioning becomes effective in reduction of spasticity overandabove conventional Rx.

DEMOGRAPHIC DATA : 

8/27/2009 14 DEMOGRAPHIC DATA

DEMOGRAPHIC DATA (Cntd.) : 

8/27/2009 15 DEMOGRAPHIC DATA (Cntd.)

MEAN MAS FOR GROUPS A & B : 

MEAN MAS FOR GROUPS A & B

MEAN MAS For GROUP A : 

8/27/2009 17 MEAN MAS For GROUP A

MEAN MAS For GROUP B : 

8/27/2009 18 MEAN MAS For GROUP B

DISCUSSION : 

8/27/2009 19 DISCUSSION ●Results indicate that there is significant reduction in spasticity in patients of Grp A than in patients of Grp B. ●Antispastic positioning holds the limb in a desired position and increases its function. ●Antispastic positioning prevents tightness, contracture, deformities which might follow if spasticity is not looked upon. ●This prolonged technique depends on AUTOGENIC INHIBITION. (PEDIATRICS INTERNATIONAL-AUG2005,47, 440-445)

Slide 20: 

8/27/2009 20 AUTOGENIC INHIBITION : Activity in the group Ib afferent fibers, associated with Golgi tendon organs, inhibits the homonymous alpha-motorneurons. The inhibition is disynaptic involving one interneuron and two synapses between the afferent fiber and the motor neuron. This effect is called as autogenic inhibition or autogenetic inhibition. (Text book of Human Physiology : GUYTON;CHATTERJEE)

DISCUSSION (Cntd.) : 

DISCUSSION (Cntd.) ●This inhibition makes selective movements possible and helps the patient to develop and increase control over disinhibited action. ●Through these positioning their movements are challenged into more normal patterns of function. (ADULT HEMIPLEGIA – BERTA BOBATH) ●Significant reduction in spasticity was noticed with antispastic positioning in patients having lower grades of spasticity.

LIMITATIONS : 

8/27/2009 22 LIMITATIONS ●Small sample size. ●There is no evidence about the duration of inhibition. ●Lack of more sensitive assessment methods like electrophysiological methods of determining H-response(mv), H/M ratios. ●Patients taken were within 1 yr. duration of injury. ●Further, studies about the effectiveness of antispastic position with different types of UMN disorders needs to be investigated by objective methods.

CONCLUSION : 

8/27/2009 23 CONCLUSION ●ANTISPASTIC POSITIONING (NWB) becomes effective as an adjunct to conventional Rx. ●ANTISPASTIC POSITIONING can be recommended as a home exercise program to the patients.

REFERENCES : 

8/27/2009 24 REFERENCES Pediatrics International, August - 2005 Voume - 47, Pg: 440-445. Journal of Rehabilitation Research & Development, February – 2000, Volume 37. Fetz EE et al, Journal Physiology (Lond)293: 173-195, 1979.  Text book of Human Physiology : GUYTON; CHATTERJEE.

Slide 25: 

8/27/2009 25 Spasticity – assessment : a review, F Biering-Sorensen, J B Nielsen and K Klinge; Spinal cord, April-2006, Vol-44, Pg:708-722. Adult Hemiplegia - Berta Bobath.  Blackburn M, van Vliet P, Mockett SP. Reliability of measurements obtained with the Modified Ashworth scale in the lower extremities of people with stroke. Phys Ther 2002; 82: 25–34.   Textbook of Physical Rehabilitation (Assessment and Treatment) SUSAN O’ SULLIVAN.

Slide 26: 

8/27/2009 26 THANK YOU FOR YOUR ATTENTION

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