Efficacy of different modalities on spasticity management of spinal cord injury : clinical and electrophysiological study

Abstract EN

Objective : to evaluate the effectiveness of TENS (versus oral anti- spasticity drugs and physical therapy alone) on management of spinal cord injury (SCI) spasticity.

Also, to study the role of the clinical and electrophysiological methods of assessment of spasticity.

Methodology : this study was performed on 40 patients with traumatic spinal cord injury suffering from spasticity.

They were 24 males (60 %) and 16 females (40 %), their ages ranged from 35 to 45 years with a mean + SD of 38.9 +2.9 years.

The patients were randomized into 3 treatment groups : Group(I): included 15 patients who were taking oral anti-spasticity drugs in the form of baclofen and tizanidine and performed physical therapy program (1 session daily) for 6 weeks.

Group (II): included 15 patients who were subjected to TENS therapy applied to spastic lower limbs, lasting for 15 minutes daily and performed the same previous physical therapy program for 6 weeks.

Group (III) : included 10 patients who were subjected to the same previous physical therapy program only daily for 6 weeks.

Spasticity of these patients was evaluated clinically by : Lower Limb Ashworth score (LLAS), ankle clonus scale, Modified Barthes Index (MBI), and Walking Index for Spinal Cord Injury (WISCI) and electro physiologically by: H reflex including H amplitude, H max / M max ratio and H latency.

These evaluations were performed at the initial presentation and after 6 weeks of the treatment program.

Results : there was a highly significant difference (p < 0.001) between the pre and post treatment assessments in group (II) in all clinical parameters and H amplitude and H max / M max ratio, the same results were obtained in group (I) except for ankle clonus scale which showed significant difference (p < 0.05), while in group (III) this significant difference was shown as regards MBI, H amplitude and H max / M max ratio.

There was significant difference in all clinical and electrophysiological parameters when comparing groups (II) & (III), but when comparing groups (I) & (III), this result was seen as the previous except in ankle clonus scale and MBI.

But when comparing groups (I) & (II), there was non-significant difference in all parameters.

Also, group (I) showed significant correlation between H amplitude and all clinical parameters except WISCI (showed non-significant correlation), while H max / M max ratio showed highly significant correlation between it and LLAS and significant correlation between it and ankle clonus scale and WISCI.

In group (II) there were non-significant correlation between both H amplitude and H max / M max ratio and LL AS and ankle clonus scale and significant correlation between them and MBI and WISCI.

But, group (III) showed significant correlation between the electrophysiological (H amplitude and H max / M max ratio) and the clinical parameters except between H max / M max ratio and MBI, there was no significant correlation detected.

Conclusion : TENS is an effective, economic, non-invasive and readily applicable method that has few side effects.

It can be used as a supplement to other treatment methods (oral medication, TENS and physical therapy) in its management.