Index to Chiropractic Literature
Index to Chiropractic Literature
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ID 22827
  Title Botulinum toxin type A combined with neurodynamic mobilization for lower limb spasticity: A case report [case report]
Journal J Chiropr Med. 2013 Mar;12(1):39-44
Peer Review Yes
Publication Type Case Report

Objective: This case report describes a patient with severe lower limb spasticity treated with botulinum toxin type A (BoNT-A) and neurodynamic mobilization (NM).

Clinical Features: An 81-year-old male patient presented with a severe spastic lower limbs after total right hip replacement and severe alcoholic polyneuropathy. After the right hip replacement, he presented with generalized spasticity, crouched posture, and a large sacral pressure sore. The severe spasticity in his knees prevented walking.

Intervention and Outcome: The patient underwent combined treatment with BoNT-A and NM of the lower limb in 4 weekly applications. Evaluations were performed pretreatment, 4 weeks after the injection, and at a follow-up session 9 months after finishing treatment. We measured the following outcomes: pain by the Numerical Rating Scale, spasticity by the Modified Ashworth Scale for Grading Spasticity, acceptance and emotional reaction to the treatment by the Hospital Anxiety and Depression Scale, and functionality by ranges of motion. We found that the patient improved in all of the outcomes after treatment, and these results were maintained during the follow-up. After treatment, the patient was able to improve wound healing by properly positioning himself in bed or on his wheelchair and walking with help. At the follow-up evaluation, the results were maintained. The patient showed good acceptance and decreased anxiety/depression after treatment.

Conclusion: For this patient, the combination of NM and BoNT-A treatment decreased pain and spasticity and improved joint ranges of motion.

This abstract is reproduced with the permission of the publisher; click on the above link for free full text.


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