[Scuba diving -- a therapeutic option for patients with paraplegia].
OBJECTIVE
Spasticity is often a handicap in paraplegics and interferes with quality of life. Medical therapeutic options (e.g. baclofen, tizanidin) lead to drowsiness, fatigue and loss in activity. On the other hand paraplegics are increasingly active in daily life and leisure (paralympics). Neurorehabilitation is effective in reduction of spasticity, gaining motor function and enhancing quality of life. Hippotherapy (Lechner et al 2003) and aquatic rehabilitation are additive methods. Already 15 years ago Madorsky et al pointed out SCUBA diving as a positive neurorehabilitation procedure. The study group around Stanghelle reported also beneficial aspects on spasticity of patients with spinal cord injuries. These references inspired to introduce a prospective study.


METHODS
After obtaining an ethic votum and evaluation assessment for diving permission 6 volunteers with paraplegia entered the pilot study. Medication was kept stable throughout the study time. Supervised by diving instructors and a diving trained doctor the volunteers dived to a platform in the depth of 7.2 meters. The daily diving time was exactly 30 minutes. Stabilized on the platform physiotherapeutic assessment took place in different positions to reduce spasticity. Ashworth Scale and spasm frequency scale were noted daily and at beginning and end of the study the WHO Quality of life Test had to be completed. For objective reasons a locomat training happened before, within a week after and 4 weeks after the study week.


RESULTS
All patients did the daily dives without any difficulties. The statistics included the assessment of day 1 versus day 7 of 5 patients and showed a significant reduction of Modified Ashwoth Scale (p=0.04). Quality of life showed an improvement.


CONCLUSIONS
The improvement rationale can only be supposed. A correlation to the ambient pressure suggests itself. Therefore deeper depths should increase the good spasticity results or manage to achieve those faster. Many questions remain, so further studies are necessary to ascertain the ideal standard options.
Haydn
Tanja
T
Brenneis
Christian
C
Schmutzhard
Joachim
J
Gerstenbrand
Franz
F
Saltuan
Leopold
L
Schmutzhard
Erich
E
D000328:Adult; D004242:Diving / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010264:Paraplegia / Q000209:etiology / Q000523:psychology / Q000534:rehabilitation*; D010342:Patient Acceptance of Health Care / Q000523:psychology; D026741:Physical Therapy Modalities / Q000523:psychology; D010865:Pilot Projects; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D013035:Spasm / Q000523:psychology / Q000534:rehabilitation