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Decrease of hypertonia after continuous passive motion treatment in individuals with spinal cord injury

Physical Therapy Department and Graduate Institute of Rehabilitation Science, Chang Gung University, Tao-Yuan, yjchang{at}mail.cgu.edu.tw

Chia-Ying Fang

Department of Rehabilitation Technology, Tzu-Hui Institute of Technology, Ping-Tung

Miao-Ju Hsu

Faculty of Physical Therapy, College of Health Science, Kaohsiung Medical University and Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung

Hen-Yu Lien

Physical Therapy Department and Graduate Institute of Rehabilitation Science, Chang Gung University, Tao-Yuan, Taiwan

Mei-Kwan Wong

Physical Therapy Department and Graduate Institute of Rehabilitation Science, Chang Gung University, Tao-Yuan, Taiwan

Objective: To examine the effect of ankle continuous passive motion on the reflex excitability and overall hypertonia of calf muscles in individuals with chronic spinal cord injury and without physical disabilities.

Design: Two-way repeated measure experimental design.

Setting: Inpatient rehabilitation department in general hospital.

Subjects: The spinal cord injury group comprised eight individuals with chronic complete spinal cord injury and the control group comprised eight healthy people without physical disabilities. An additional eight healthy people were recruited as the sham group.

Interventions: Each subject received 60 min of continuous passive motion on the ankle joint.

Main measures: The H-reflex of the soleus muscle was elicited by tibia nerve stimulation just before, immediately after, and 10 min after continuous passive motion. The Modified Ashworth Scale (MAS) score at the ankle joint was recorded for the spinal cord injury group just before and 10 min after continuous passive motion therapy.

Results. After 60 min of continuous passive motion of the ankle joint, the H-reflex amplitude at the soleus muscle was depressed in individuals with and without spinal cord injury (77.46 ± 32.64%, P = 0.047 and 51.76 ± 26.74% of initial, P<0.0001, respectively). This depression persisted up to 10 min after continuous passive motion only in individuals without spinal cord injury. In individuals with spinal cord injury, the median of MAS scores decreased from 2 to 1.25 after continuous passive motion.

Conclusion: Sixty minutes of continuous passive motion of the ankle joint decreased reflex excitability and overall hypertonia in people with or without spinal cord injury. The depression of overall hypertonia persisted longer than the reflex excitability in people with spinal cord injury.

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