S-2-10-01
Spastic movement disorder
Volker Dietz (Swiss Paraplegic Center, University Hospital Balgrist Zurich, Switzerland)
Following central motor lesions the development of spastic muscle tone represents a form of reorganization which leads to an improved mobility following limb paralysis. Tension development is different from normal during spastic gait and appears to be largely independent of exaggerated monosynaptic stretch reflexes. Exaggerated stretch reflexes are associated with an absence or reduction of functionally essential polysynaptic reflexes. When supraspinal control of spinal reflexes is impaired, the inhibition of monosynaptic reflexes is missing in addition to a reduced facilitation of polysynaptic reflexes. Therefore, overall leg muscle activity becomes reduced and less well modulated in patients with spasticity. Electrophysiological and histological studies have shown that a transformation of motor units takes place associated with a contracture of muscle fibres following central motor lesions with the consequence that regulation of muscle tone is achieved at a lower level of neuronal organization which in turn enables the patient to walk.
S-2-10-02 Restoration of locomotion in paraplegic patients
Hesse S
The presentation will deal with our experience in the field of electrical stimulation, treadmill training with partial body weight support and botulinum toxin injection for the treatment of lower limb spasticity. 17 SCI patients with a clinically complete lesion received FES for restoration of standing and walking: standing was achieved within one month, walking ability reached from 3 to 330 m. After one year 90% of the patients abandoned FES-assisted walking and continued FES-assisted standing and cyclic stimulation in over 60%. Improved physical fitness and muscle trophic were rated positive whereas unfulfilled expectations and increase of flexor spasticity in two cases were rated negative.
Incomplete patients are treated with the help of a treadmill with partial body weight support. Assisted by two therapists they tram complete gait cycles thereby improving markedly their gait ability. The training is combined with FES to relieve the therapists from their strenous work and maybe to further enhance the restoration of gait. Recent studies show that patients walk more symmetrical on the treadmill, that the body weight support enhances the activity of the glutaeus medius and that highly paretic muscles become phasically activated during the therapy.
In case of focal spasticity Botulinum toxin is injected into the lower limb muscles, for enhancement of activity the muscles are stimulated for three days (3 hours 7 each day). This modification is based on the fact that the activity of the terminal nerve ends is correlated with the uptake and efficacy of the toxin.
