Comparative study of neurodevelopment treatment with or without BTX-A (Dysport) injection in the management of spasticity of hemiplegic patients

Introduction: Spasticity is one of the motor disorders of upper motor neuron that it• • s mechanisms, assessment and treatment are usually troublesome. Different methods of treatment have been presented for control of spasticity. One of them is treatment according to Bobath• • s method (NDT). Recent studies show that injection of BTX-A (Dysport) into spastic muscles can reduce spasticity. The aim of this study was to compare the effect of neurodevelopment treatment (NDT) with BTX-A injection and NDT alone in reduction of spasticity and improvement the quality of movement patterns of lower limb in hemiplegic patients. Methods: Twenty hemiplegic patients (9 female, 11 male) with age ranging from 41 to 78 years participated in this study. They were in spastic phase and could have been walked with or without assistive device. Severity of spasticity according to original ashworth scale (OAS) was between 1 to 3. In group one patients were treated by NDT method and in group two (2,4,6,8,10) patients were treated by NDT and BTX-A injection. Baseline assessments consisted of: spasticity severity in plantar flexor’s muscles according to OAS, active and passive range of motion of ankle joint and quality of movement patterns of lower limb in standing position according to NDT. Injection of BTX-A was performed in gastrocnemius muscle (200 u in 4 sites of medial and lateral heads), soleus muscle (75 u in 2 sites) and tibialis posterior muscle (50 u in 2 sites). NDT in two groups was performed by 10 sessions. Results: In two groups, decreasing of OAS, increasing of active and passive range of motion and quality of movements patterns were seen. All of this changes were more significant in group 2. In each group, severity had been significant correlation with recovery according to OAS and quality of movement patterns. Conclusion: NDT with inhibition of abnormal patterns, facilitation of normal responses and increasing the ability of patient to perform discrete movements in spite of presence of synergic movement patterns can reduce spasticity, increase range of motion and quality of movement patterns. Direct effect of BTX-A on muscle tone and reduction of spasticity can increase the effectiveness of neurodevelopment treatments.