Villafañe Jorge H
Physical Therapist, Department of Physical Therapy, Residenza Sanitaria Assistenziale "A. Maritano," Sangano, Italy.
J Chiropr Med. 2013 Mar;12(1):39-44. doi: 10.1016/j.jcm.2013.01.001.
This case report describes a patient with severe lower limb spasticity treated with botulinum toxin type A (BoNT-A) and neurodynamic mobilization (NM).
An 81-year-old male patient presented with a severe spastic lower limbs after total right hip replacement and severe alcoholic polyneuropathy. After the right hip replacement, he presented with generalized spasticity, crouched posture, and a large sacral pressure sore. The severe spasticity in his knees prevented walking.
The patient underwent combined treatment with BoNT-A and NM of the lower limb in 4 weekly applications. Evaluations were performed pretreatment, 4 weeks after the injection, and at a follow-up session 9 months after finishing treatment. We measured the following outcomes: pain by the Numerical Rating Scale, spasticity by the Modified Ashworth Scale for Grading Spasticity, acceptance and emotional reaction to the treatment by the Hospital Anxiety and Depression Scale, and functionality by ranges of motion. We found that the patient improved in all of the outcomes after treatment, and these results were maintained during the follow-up. After treatment, the patient was able to improve wound healing by properly positioning himself in bed or on his wheelchair and walking with help. At the follow-up evaluation, the results were maintained. The patient showed good acceptance and decreased anxiety/depression after treatment.
For this patient, the combination of NM and BoNT-A treatment decreased pain and spasticity and improved joint ranges of motion.
本病例报告描述了一名患有严重下肢痉挛的患者，接受了A型肉毒毒素（BoNT-A）和神经动力松动术（NM）治疗。
一名81岁男性患者在全右髋关节置换术后出现严重下肢痉挛，并伴有严重酒精性多发性神经病。右髋关节置换术后，他出现全身痉挛、蹲伏姿势和巨大的骶部压疮。他膝盖的严重痉挛妨碍了行走。
患者每周接受一次BoNT-A和下肢NM联合治疗，共4次。在治疗前、注射后4周以及治疗结束后9个月的随访时进行评估。我们测量了以下结果：用数字评定量表评估疼痛，用改良Ashworth痉挛评定量表评估痉挛程度，用医院焦虑抑郁量表评估对治疗的接受度和情绪反应，用关节活动范围评估功能。我们发现患者治疗后的所有结果均有改善，且这些结果在随访期间得以维持。治疗后患者能够通过在床上或轮椅上正确摆放姿势以及在他人帮助下行走来促进伤口愈合。在随访评估时，结果得以维持。患者治疗后表现出良好的接受度，焦虑/抑郁情绪减轻。
对于该患者，NM和BoNT-A联合治疗减轻了疼痛和痉挛，改善了关节活动范围。
