Bacca Ramirez O.A.1,2, Herrera Villabona E.1,2, Patiño Segura M.S.1,2
1Universidad Industrial de Santander, Santander, Bucaramanga, Colombia, 2Physical Therapy School, Santander, Bucaramanga, Colombia
Background: Spasticity is one of the major events that generate altered sensorimotor after Stroke. To reduce the reflex excitability of alpha motor neurons in spastic muscles have been used Inhibition Techniques (IT) and the Johnstone pressure splint (JPS), however, there is controversy about the effectiveness of these interventions. The air splint is an intervention tool that can help sensory reeducation and spastic muscle inhibition due to the effect of pressure and stretching generated on skin, joint and muscle receptors.
Purpose: Evaluate the immediate effect of the IT and JPS on reflex excitability of plantiflexores muscles in subjects with Stroke.
Methods: An experimental single blind study was performed. Participants were randomly assigned to two intervention groups: Control Group (IT) and Experimental Group (IT and JPS). The treatment session had a duration of 25 minutes for both groups and the splint was inflated to 40 mmHg. In sitting position, two measurements of the soleus H-reflex in the lower limb paretic were performed (baseline and immediately after the end of treatment). The electrophysiological parameters of H-reflex were: latency (ms), amplitude (mV), duration of M and H waves (ms) and the amplitude index Hmax / Mmax. All analyses were conducted in Stata 13.0 software, and Shapiro Wilk test for normality of the variables was used. Also, measures of central tendency and dispersion (mean and standard deviation or median and interquartile range) were calculated. The paired Student T test and Wilcoxon rank were applied to evaluate the differences within each group. To establish differences between groups analysis of covariance (ANCOVA) was used.
Results: 26 subjects with ischemic and hemorrhagic Stroke participated (17 men and 9 women), aged 60.1 ± 5.9 years and evolution time 25.4 ± 14.3 months with a range from 1+ and 3 in the Modified Ashworth Scale (MAS). In the analysis within each group it found that the median duration of the M wave was increased in the Control Group CG (pre: 7(2.3) ms vs post: 8(1.5) ms, p=0.01), while the median amplitude of the H wave decreased in the Experimental Group EG (pre: 3.36(2.2) mV vs post: 0.96(0.78) mV, p=0.01). In the analysis between groups it was found a significant decrease in the duration of H wave (CG: 8.29±1.7 ms vs EG: 6.54±1.2 ms, p=0.01) and median M wave (CG: 8(1.5)ms vs EG: 6(1.4) ms, p=0.005) in the EG.
Conclusion(s): The inmediate effect of IT and JPS that could be related to the decrease in excitability of plantiflexores muscles, however, it is important to propose new research on the effectiveness of the air splint and its role as a complementary method of intervention in the treatment of spasticity post-Stroke.
Implications: The air splint is a tool which can be adapted to any limb and functional activity, allowing integrate the conventional physiotherapy treatment to inhibit spasticity.
Funding acknowledgements: The Universidad Industrial de Santander gave all the monetary support
Topic: Neurology: stroke
Ethics approval: Approval of this study was granted through the Universidad Industrial de Santander IRB in accordance the Declaration of Helsinki
All authors, affiliations and abstracts have been published as submitted.
