The use of hydrotherapy for the management of spasticity.
BACKGROUND
Spasticity is a major problem for the rehabilitation team. Physiotherapy is a vital component of therapy. Oral medication and other modalities such as heat, cold, ultrasound, electrical stimulation, and surgery (neuro-surgical or orthopedic) can also be used. The aim of this study was to compare the effects of hydrotherapy on spasticity and Functional Independence Measure (FIM) scores of patients with spinal cord injury (SCI).


METHODS
This is a control case matched study. Twenty SCI patients were divided into 2 groups and matched for age, gender, injury time, Ashworth scores, oral baclofen intake, American Spinal Injury Association, and FIM scores. The control group received passive range of motion exercise twice a day and oral baclofen for 10 weeks. The study group also received passive range of motion and oral baclofen, as well as 20 min of water exercises (at 71 degrees F, full immersion) 3 times per week. The authors evaluated spasm severity, FIM scores, oral baclofen intake, and Ashworth scales, between groups at the beginning and at the end of the treatment period.


RESULTS
Both groups demonstrated a significant increase in FIM scores. However, the hydrotherapy group demonstrated a larger increase (P < 0.0001) than the control group. There was a statistically significant decrease in oral baclofen intake in the hydrotherapy group (P < 0.01). There was no statistical change in the control group. Spasticity was evaluated by the Ashworth scale. There was a statistical improvement in each group (P < 0.01, P < 0.02). However, when compared to the control group, the use of hydrotherapy produced a significant decrease in spasm severity (P < 0.02).


CONCLUSIONS
Side effects are often seen when using oral drug treatment for spasticity. Adding hydrotherapy to the rehabilitation program can be helpful in decreasing the amount of medication required. Future studies must evaluate benefits of hydrotherapy for rehabilitation.
Kesiktas
N
N
Department of Physical Medicine and Rehabilitation, Istanbul Medical Faculty, Istanbul University, Turkey. nkesiktas@superonline.com
Paker
N
N
Erdogan
N
N
Gülsen
G
G
Biçki
D
D
Yilmaz
H
H
D000203:Activities of Daily Living; D000284:Administration, Oral; D000328:Adult; D001418:Baclofen / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D006875:Hydrotherapy; D008297:Male; D009125:Muscle Relaxants, Central / Q000008:administration & dosage; D009128:Muscle Spasticity / Q000188:drug therapy / Q000534:rehabilitation* / Q000628:therapy*; D013119:Spinal Cord Injuries / Q000534:rehabilitation* / Q000628:therapy*
D009125:Muscle Relaxants, Central; D001418:Baclofen