Kesiktas N, Paker N, Erdogan N, Gülsen G, Biçki D, Yilmaz H
Department of Physical Medicine and Rehabilitation, Istanbul Medical Faculty, Istanbul University, Turkey.
Neurorehabil Neural Repair. 2004 Dec;18(4):268-73. doi: 10.1177/1545968304270002.
Spasticity is a major problem for the rehabilitation team. Physiotherapy is a vital component of therapy. Oral medication and other modalities such as heat, cold, ultrasound, electrical stimulation, and surgery (neuro-surgical or orthopedic) can also be used. The aim of this study was to compare the effects of hydrotherapy on spasticity and Functional Independence Measure (FIM) scores of patients with spinal cord injury (SCI).
This is a control case matched study. Twenty SCI patients were divided into 2 groups and matched for age, gender, injury time, Ashworth scores, oral baclofen intake, American Spinal Injury Association, and FIM scores. The control group received passive range of motion exercise twice a day and oral baclofen for 10 weeks. The study group also received passive range of motion and oral baclofen, as well as 20 min of water exercises (at 71 degrees F, full immersion) 3 times per week. The authors evaluated spasm severity, FIM scores, oral baclofen intake, and Ashworth scales, between groups at the beginning and at the end of the treatment period.
Both groups demonstrated a significant increase in FIM scores. However, the hydrotherapy group demonstrated a larger increase (P < 0.0001) than the control group. There was a statistically significant decrease in oral baclofen intake in the hydrotherapy group (P < 0.01). There was no statistical change in the control group. Spasticity was evaluated by the Ashworth scale. There was a statistical improvement in each group (P < 0.01, P < 0.02). However, when compared to the control group, the use of hydrotherapy produced a significant decrease in spasm severity (P < 0.02).
Side effects are often seen when using oral drug treatment for spasticity. Adding hydrotherapy to the rehabilitation program can be helpful in decreasing the amount of medication required. Future studies must evaluate benefits of hydrotherapy for rehabilitation.
痉挛是康复团队面临的一个主要问题。物理治疗是治疗的重要组成部分。也可使用口服药物以及其他治疗方式，如热疗、冷疗、超声、电刺激和手术（神经外科或骨科手术）。本研究的目的是比较水疗对脊髓损伤（SCI）患者痉挛及功能独立性测量（FIM）评分的影响。
这是一项对照病例匹配研究。20例SCI患者被分为两组，在年龄、性别、损伤时间、Ashworth评分、口服巴氯芬摄入量、美国脊髓损伤协会分级及FIM评分方面进行匹配。对照组每天接受两次被动关节活动度训练，并口服巴氯芬，持续10周。研究组除接受被动关节活动度训练和口服巴氯芬外，还每周进行3次20分钟的水中训练（水温71华氏度，全身浸入）。作者在治疗期开始和结束时评估了两组之间的痉挛严重程度、FIM评分、口服巴氯芬摄入量及Ashworth量表评分。
两组的FIM评分均显著提高。然而，水疗组的提高幅度大于对照组（P < 0.0001）。水疗组的口服巴氯芬摄入量有统计学意义的下降（P < 0.01）。对照组无统计学变化。采用Ashworth量表评估痉挛情况。两组均有统计学意义的改善（P < 0.01，P < 0.02）。然而，与对照组相比，水疗的使用使痉挛严重程度显著降低（P < 0.02）。
使用口服药物治疗痉挛时经常会出现副作用。在康复计划中增加水疗有助于减少所需药物的用量。未来的研究必须评估水疗对康复的益处。
