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

ABSTRACT

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. 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 Barthel Index [MBI], and Walking Index for Spinal Cord Injury [WISCI] and electrophysiologically 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. 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] and [III], but when comparing groups [I] and [III], this result was seen as the previous except in ankle clonus scale and MBI. But when comparing groups [I] and [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. 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