| 제목 |
The effectiveness of ETOIMS in improving gait speed in patient with spastic paraplegia:A pilot study |
| 소속 |
Department of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea1, Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Gyeonggi Province, Korea2, Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea3 |
| 저자 |
Sanghoon Shin1*, Juntaek Hong1, Doyoung Kim3, Soojin Choi2, Jung Hyun Park3, Jinyoung Park3† |
Object
Patients with a lesion below the spinal cord T1 level can develop spastic paraplegia and show reduced gait speed due to spasticity as well as weakness. In this study, we applied electrical twitch obtaining intramuscular stimulation (ETOIMS) to the spastic paraplegic patients with gait disturbance. The ETOIMS is a method to alleviate pain and achieve muscle relaxation by eliciting muscle twitching with electrical stimulus to the deep motor end-plate zone (MEPZ) by a monopolar needle. We present paraplegia patients who underwent ETOIMS alongside conventional stretching, strengthening exercises, and gait training, and showed improved gait speed and pattern due to muscle relaxation.
Method
We enrolled previously diagnosed spastic paraplegic patients who visited the department of rehabilitation medicine of a tertiary hospital with a complaint of gait disturbance between March 2017 and March 2018. Electrical stimulation was delivered by a monopolar needle electrode with 2-mA intensity, 0.2-ms pulse duration, and 1-Hz frequency with unipolar negative waves for 10 seconds at each stimulation point, which induced muscle twitching. The target muscles were the bilateral quadratus lumborum, multifidus originating from L4 and L5 spinous process, and gluteus medius. The participants underwent a 50-m gait test before and after ETOIMS. The gait speeds, subjective symptom changes, and gait patterns were compared before and after the interventions.
Result
Total 5 patients were enrolled and basic characteristics of the patients are shown in Table 1. The diagnoses were as follows; cervical myelitis (n=1), hereditary spastic paraplegia (NIPA1 mutation) (n=1), spinal cord tumor (n=2) and spinal cord injury (n=1). The ages were ranged from 26 to 70 years. The ambulatory motor index varied from 18 to 30. The walking aids and the antispasmodic agents in use are listed in Table 1. Tables 2 and 3 show the changes of gait parameters, stiffness and muscular pain after the ETOIMS. All patients subjectively reported the reduced stiffness during walking, and the alleviated muscular pain. After the 1st ETOIMS, the patient 1~4 showed 57%, 29%, 33%, 6% improvement in gait speed respectively. The patient 1 showed a cumulative effect in gait speed by following two interventions, showing total 167% improvement. During gait, increased pelvic dissociation was observed. None reported any complication except for mild soreness at the stimulated sites, relieved within 2 days.
Conclusion
The ETOIMS is effective in improving gait speed and stability via relaxing the muscles or alleviating the pain in the lower back and gluteus in patient with spastic paraplegia. It is a promising minimally invasive intervention because it is easy to be performed without anesthesia, needs no injectate and the side effects are very minor. As this study is a pilot study without a control group, further controlled study is needed. |
|
Table 1. Basic characteristics of the patients
Table 2. ETOIMS effects for spastic gait
Table 3. Gait patterns and patient’s symptom reports before and after ETOIMS
|
