paraplegia

[muhana85d]

hello every one

I am now treating paraplegic pateint as result from explosive injuries and had fragments at T11- T12 lead to injury of spinal cord
he had three operations in egypt to implant myele in spinal cord at site of injury
Now the patient have spasticity and knee reflex in left lower limb and also have spasticity in right lower limb but there is no visible knee reflex
but the pateint's big toes ( hallux) is continues in dorsiflex all time and the other fingers is planter and when I put the pateint on standing table the big
toe's return to normal position and the color of the legs becom Purplish and rturn to normal in horizontal positions

I use with him passive ROM & standing table

My question is what other methods and exersices can I use with him and if I want to use electrical stimulation what the type of current and waveform will use it ? and thank you for every one

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[charlize29]

Hi Muhana,

This is actually a useful website for SCI patients which etvin posted recently in the forum.

http://www.physiotherapyexercises.com/web2/index.php -follow this site
www.physiotherapyexercises.com

[muhana85d]

thank you charlize

but i want mainly know about current use with him \ what's the type of current I will use with him to prevent atrophy and muscles spasm

[ramywhite]

Hi muhana85d,
I don't recommend electrical stimulation for spastic paraplegia. It is better if you concentrate in exercises like mat exercises and standing. T12 level injury has many problems in equilibrium, sitting, transferring. Examine him carefully and wright down his problems and then treat each one. Help him to sit alone and use wheelchair and learn him how to roll to each side and how to transfer from mat to chair and all his ADLs. Examine him and ask him what are his main problems.
And we are here for any further help.

[Oonagh]

Hi there,
You don't say how long your patient is post injury or if he has any return of voluntary muscle power. Re: electrical stimulation I have found it to be quite useful in tone reduction. Two approaches can be used - either treating agonist/antagonist at 35Hz(alternating) or 10Hz on spastic muscle and 40Hz on antagonist. I would use the latter if he has some degree of return even if masked by the spasticity. Also I would use a lot of Bobath techniques. Addressing the trunk with a lot of rotational and contrarotational mobilizations is also very useful for trunk reduction. Good luck. Oonagh

[charlize29]

Hi Muhana,

FES ( Functional Electrical Stimilation) is useful for paraplegic patients in biped gait. However, it cannot be used for VERY SEVERE SPASTICITY. Here's the link of an article which I think would be able to give you an idea on "Gait Restoration in paraplegic patients using Mutichannel Surface Electrodes FES.

http://www.rehab.research.va.gov/jou.../pdf/kralj.pdf

Goodluck!!!

Regards,
Charlize29