Botulinum toxin type A for rehabilitation after a spinal cord injury: a case report.
A 56-year-old man became quadriplegic, bed bound, and carer-dependent secondary to cervical osteomyelitis. Three years later, he presented with generalised spasticity, crouched posture, and a large sacral pressure sore. The severe spasticity in his hips and knees prevented ischial sitting. Injections of botulinum toxin type A to both hamstrings and gastrosoleuii controlled the flexor spasticity of his lower limbs and facilitated rehabilitation and wound healing through proper positioning, wound care, stretching, and weight-bearing exercises. A few weeks later, the patient could better position himself in bed (prone lying) and on his wheelchair (ischial sitting). His spasm-related pain lessened and his mobility and activities of daily living improved. The sacral pressure sore healed completely a few months later. The patient could sleep better, feed with set-up and adaptive aids, groom, dress, and transfer himself with minimal assistance. The effects of botulinum toxin extended beyond just spasticity reduction. His upper extremity function, mobility, and social well-being were all improved through better positioning.
Naicker
A S
AS
Department of Orthopaedics and Traumatology, Faculty of Medicine, HUKM, Kuala Lumpur, Malaysia. asnaicker@yahoo.com
Roohi
S A
SA
Chan
J L L
JL
D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002574:Cervical Vertebrae; D006801:Humans; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010019:Osteomyelitis / Q000150:complications / Q000473:pathology / Q000628:therapy; D011782:Quadriplegia / Q000188:drug therapy* / Q000209:etiology / Q000534:rehabilitation*; D013119:Spinal Cord Injuries / Q000150:complications* / Q000628:therapy*
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A