Effect of baclofen combined with neural facilitation technique on the reduction of muscular spasm in patients with spinal cord injury

摘要

BACKGROUND: Recent researches have demonstrated that baclofen is a commonly central anti-spasm drug. In addition, neural facilitation technique based on nerve development and neurophysiology is widely used for rehabilitation training of motor disorder after central nerve injury. However, whether baclofen combining with neural facilitation technique can relieve muscular spasm after spinal cord injury needs further studies.OBJECTIVE: To observe the effect of baclofen combining with neural facilitation technique on decreasing muscular tension in two lower extremities after spinal cord injury.DESIGN: Randomized controlled study.SETTING: Departments of Rehabilitation and Orthopaedics, the Third Affiliated Hospital of Guangzhou Medical College.PARTICIPANTS: A total of 28 patients with spinal cord injury, including 17 males and 11 females, whose age ranged from 31 to 71 years, were selected from Departments of Rehabilitation and Orthopaedics, the Third Affiliated Hospital of Guangzhou Medical College from March 2005 to September 2006. The illness course ranged from 22 to 54 days and the mean course was (38 ± 8) days. All patients were diagnosed as the first onset and the increase of extensor muscular tension in two lower extremities after thoracic vertebra injury by using spine MR or CT examination. Informed consents were obtained from all the patients.METHODS: All 28 patients who had upper motor neuronal paralysis in two lower extremities after spinal cord injury in thoracic vertebra region were randomly divided into treatment group and control group with 14 cases in each group. Patients in both groups received routine therapy, while those in the treatment group were treated with oral baclofen (the beginning dosage: 5 mg/time; three times per day, 5 mg was increased every three days; the maximal dosage was 60 mg/day; 6 weeks in total) (made in Weicai Pharmaceutical Co., Ltd.;tablet; batch number: HC20040029) combining with neural facilitation technique, which accorded to Rood technique (slight joint extrusion, slow and persistent stretch, etc.), Brunnstrom technique (non-symmetric cervical reflex: head turning to one side promoting contralateral flexuosity in both upper and lower extremities) and Bobath technique (reflective inhibition, such as reducing supine position; increasing lateral recumbent position, rolling in bed and posture transfer; controlling key sites; 6 weeks in total).MAIN OUTCOME MEASURES: At 6 weeks after treatment, modified Ashworth grading method and Barthel Index were used to detect extensor muscular tension in two lower extremities and activities of daily living (ADL) of patients in both groups.RESULTS: ① Grade of muscular tension in two lower extremities: At 6 weeks after treatment, muscular tension in the treatment group was classified into grade Ⅰ (n =12), gradeⅡ (n =2) and grade Ⅲ(n =0),which was markedly improved as compared with that in the control group [grade Ⅰ (n =6), grade Ⅱ (n =4) and grade Ⅲ (n =4)]. In addition, there was significant difference between the two groups (P ＜ 0.05). ② ADL ability: Barthel Index of patients with complete and incomplete spinal cord injury in the treatment group was higher than that in the control group at 6 weeks after treatment, and there was significant difference between them (P ＜ 0.05).CONCLUSION: Baclofen combining with neural facilitation technique can not only remarkably relieve muscular tension of upper motor neuronal paralysis after spinal cord injury, but also obviously accelerate recoveries of motor functional and ADL ability.