Proposed Topic (Most preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors (including presenting author) :
Wong SYR (1), Fung KYB (1)
Affiliation :
(1) Physiotherapy Department, Kwong Wah Hospital
Introduction :
Repetitive peripheral magnetic stimulation (rPMS) is an emerging treatment modality for spasticity in neurological cases. The principle of action is based on the induction of an electromagnetic field that interacts with human body tissues that subsequently giving rise to electric currents to reduce spasticity. The Super Inductive System (SIS)- influence the depolarization of neuronal cells, generating therapeutic effects such as: analgesia, myostimulation, and trophic, resorptive, and elasticizing effects.
Objectives :
In this study, the effect of using the SIS for spasticity reduction in an incomplete paraplegic patient after spinal surgery was being evaluated.
Methodology :
A 38 years old female suffering from schwannoma after laminectomy of T10 & T11 with removal of tumour done. Lower limbs spasticity gradual developed after three months of rehabilitation. The spasticity of the lower limbs caused pain and weakness of lower limbs that hindered patients’ daily life such as difficulty in turning in bed, unable to lie flat prone, difficult and unstable gait. Conventional physiotherapy was already given to control/ reduce the spasticity for one months, however, the result was not quite promising. Therefore, SIS was introduced as an additional treatment for her spasticity. Protocol of spasticity reduction was adopted first to treat her R hip flexor. The applicator was placed first on the agonist (R hip flexors) muscles for 1 minutes for post-facilitatory inhibition that result in decrease in spasticity, and afterwards on the antagonist (hip extensors) muscles for 8 min to increase the muscle strength to obtain a higher blood perfusion and trophic improvement. After three weeks of SIS treatment to R hip flexor, SIS was also used to treat her L calf muscles similarly. Frequency of treatment was three times a week with intensity at 60%. SIS was given for 12 sessions and 6 sessions to patient’s R hip flexors and extensors and L calf and ankle dorsiflexors muscles respectively.
Result & Outcome :
Outcome measures:
Modifies Ashworth Scale (MAS), NPRS and 10 meters walk test (10 MWT) were used to evaluate the effectiveness of SIS in spasticity reduction.
Result:
MAS of the R hip flexors had decreased from 3 to 2, whereas that of the L calf remain same -2 post treatment. NPRS of the R hip flexors had reduced from 8 to 3; whereas that of L calf reduced from 5 to 3. Walking speed (10 MWT) had increased from 0.15m/s to 0.26m/s. After SIS treatment, the patient subjectively felt the 'hard' tight band over R hip was gone. Less stretching feeling over R hip flexors which allowed easier and smoother movement for her. Patient was found to have more hip extension during standing/ walking- thus standing and walking in a more upright posture. Besides the improvement in targeted muscles group - R hip flexors spasticity, R hip adductors spasticity also improved. Decreased scissoring episodes during turning or ambulation was observed. The reduction of adductors’ tone also facilitated easier nursing care such as changing of foley. In summary, SIS was found to be useful in spasticity reduction of this case. Further studies upon the use of this newly emerging non-invasive modality for spasticity reduction should be further explore.
