Botulinum toxin type A combined with neurodynamic mobilization for lower limb spasticity: a case report

Abstract

Objective: This case report describes a patient with severe lower limb spasticity treated with botulinum toxin type A (BoNT-A) and neurodynamic mobilization (NM). Clinical Features: 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. Intervention and Outcome: 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. Conclusion: For this patient, the combination of NM and BoNT-A treatment decreased pain and spasticity and improved joint ranges of motion.

Immediate effects of a neurodynamic sciatic nerve sliding technique on hamstring flexibility and postural balance in healthy adults

“…These findings can be explained as follows. If tension is applied to the nervous system while applying neurodynamics, the reduction of the cross-sectional area and increase in pressure in the nerve result in extension and movement of the sciatic nerve together with the hamstring and compliance of the nerve, resulting in increased flexibility [26,27].…”

Manual therapy and neurodynamic mobilization in a patient with peroneal nerve paralysis: a case report

“…11,[21][22][23] According to Nee and Butler (2006), cited in Boyd et al, 24 the criteria for interpretation of neurodynamic testing include whether the test (a) reproduces the symptoms, (b) identifies a significant deviation from normal, or (c) produces alterations in the symptoms by adding in a distal joint movement, also called sensitizing movements. 24 For example, muscle EMG activity, location of symptoms, and hip motions are altered when performing 2 sensitizing versions of the straight leg raise maneuver, assisting clinicians to Fig 3. A, Proximal slider, a straight leg raise and application of plantar-flexion without producing symptoms.…”

Efficacy of Short-Term Robot-Assisted Rehabilitation in Patients With Hand Paralysis After Stroke: A Randomized Clinical Trial

“…Each patient underwent both subjective and physical examination performed by a physician experienced in neurologic conditions and rehabilitation to evaluate the patients in regard to the inclusion and exclusion criteria. To be included in the study, the patients needed to have a history of acute phase of stroke, 41 first stroke episode, no history of peripheral nerve injury or musculoskeletal disease (eg, arthritis, musculotendinous injury, or bone fracture) in the affected upper extremity, no contracture of the affected wrist or fingers (Modified Ashworth < 3), 6 and no history of any invasive procedure (Botulinum toxin type A) for the treatment of spasticity for at least 6 months prior to the start of this study, 17,36 and paralysis of the wrist and fingers and absence in voluntarily initiating and controlling finger extension movements. The exclusion criteria included unstable medical disorders, active complex regional pain syndrome, severe spatial neglect, aphasia, or cognitive problems.…”