The effect of NDT and BTX-A injection on muscle spasticity



The aim of this study was to compare the effect of neuro-development treatment (NDT) technique and NDT plus botulinum toxin type A (BTX-A) injection on the reduction of spasticity and improvement of the quality of movement patterns of lower limb in hemiplegic patients. For this purpose, 15 hemiplegic (8 female and 7 male cases) with an age range of 27-70 years participated in this study. The patients were in spastic phase and able to walk with or without assisting device. The severity of spasticity was measured by the original Ashworth scale (OAS) and was assigned from 1 to 3. Five patients were treated using NDT method (Group A) and ten patients were treated using combination method (NDT plus BTX-A injection, Group B). BTX-A injection was performed in gastrocnemius, soleus and tibialis posterior muscles. NDT technique was performed in both groups for 10 sessions. Baseline assessments consisted of measuring the severity of spasticity in plantar flexors according to OAS, active and passive range of motion of ankle joint and the quality of movement patterns of lower limb in the standing position according to NDT. In both groups, reduced spasticity, increased active and passive range of motion and improved quality of movement patterns were observed, while the mean changes of these parameters was significantly (P<0.05) higher in group B. In each group, the rate of recovery according to the improvement of the quality of movement patterns was correlated with the severity of spastisity (P<0.05). Meanwhile, NDT technique may reduce spasticity and may increase range of motion and quality of movement patterns through an inhibitory effect on the abnormal movement patterns and facilitation of normal responses and increasing the ability of patients to perform discrete movements in spite of the presence of synergic movement patterns. Direct attenuating effect of BTX-A on muscle tone and spasticity may increase the effectiveness of NDT technique.