بررسی تاثیر درمان بر اساس تکامل سیستم عصبی و تزریق سم بوتولنیوم در بیماران مبتلا به همی‌پلژی اسپاستیک

    Background & Aim: Hemiplegia results from upper motor neuron lesion and the patient encounters complications such as spastic paralysis of limbs, weakness and disability in performing movement patterns. One of the effective treatment approaches for these patients is neurodevelopmental treatment(NDT) based on Bobath’s assumptions. On the other hand, the latest researches show that botulinum toxin can effectively reduce spasticity in spastic muscles. The aim of this study is to compare the effects of NDT techniques and NDT plus BTX-A (Botulinum Toxin Type A) injection on reduction of spasticity and improving the quality of movement patterns of lower limbs in hemiplegic patients. Patients & Method: 15 hemiplegic patients whose ages ranged from 27 to 70 participated in this study. The patients were in spastic phase and able to walk with or without supportive devices. According to OAS(Original Ashworth Scale), the severity of spasticity was assessed between 1 and 3. Five patients were treated using NDT method(Group A) and ten patients were treated using combined method(Group B). BTX-A injection was performed into the calf muscles of lower limbs. Baseline assessment consisted of measuring the severity of spasticity of plantar flexors, active and passive ROM(Range of Motion) of ankle dorsiflexion, and the quality of movement patterns of lower limbs. Results: In both groups reduced spasticity, increased active and passive ROM, and improved quality of movement patterns were seen after treatment while mean changes of these parameters were significantly higher in group B(P<0.05). Conclusion: It can be concluded that NDT techniques may reduce spasticity and increase ROM and quality of movement patterns by providing an inhibitory mechanism for abnormal movement patterns, facilitating normal responses and increasing the ability of patient to perform discrete movements in spite of the presence of synergic movement patterns. Direct effect of BTX-A on muscle tone and spasticity reduction may increase the effectiveness of NDT techniques.