Osteopathic neuromuscular rehabilitation: a novel approach to treat spasticity following systemic illness, brain tumour, and traumatic brain injury in general population

Introduction: Spasticity is a motor dysfunction represented by a velocity-dependent increase in muscle tone. About one-third of post-stroke patients are reported to experience symptomatic spasticity. This research examines the effectiveness of Osteopathic treatment with conventional physiotherapy on the spasticity of upper and lower extremities.

Method: The study design was a single-blinded, randomized controlled trial. Two hundred and fifty patients with spasticity were randomized into two groups: "conventional physiotherapy" and "conventional physiotherapy with osteopathy". The study was conducted in a private setting (non-NHS) and complied with the CONSORT (Consolidated Standards of Reporting Trials) guideline. The ethical approval was granted by the ethics committee at Anglia Ruskin University. The qualitative and quantitative measurement of spasticity was done by employing the Modified Ashworth Scale (MAS) and Myotonometer (muscle stiffness index), respectively; The effect of the spasticity was also measured by utilizing spasticity related Quality of life (SQoL6D) scoring tool at three different intervals; the beginning of the trial, month three and month six.

Result: Three hundred and twenty-five patients agreed to participate in the trial. After thorough physical and higher cognitive examination and applying the inclusion and exclusion criteria, 262 patients were recruited for the study. Conventional physiotherapy and osteopathic intervention group showed a statistically significant improvement in the upper and lower extremity spasticity at week-six (upper limb P-value= 0.05, Lower Limb Pvalue= 0.05) and week-twelve (upper limb P-value= 0.03, lower limb P-value= 0.03). There was an increase in the MAS Score in both the upper and lower limbs, a reduction in Muscle stiffness index, and an improvement of SQoL6D. The cumulative score of the SQoL6D indicated that the intervention group demonstrated statistically significant improvement in all the six groups of the muscle, which was pertinent from week six onwards (P-value < 0.05). At week six of the study, the participants reported a reduction in the amount of pain they experienced, and it decreased as they approached week twelve. The results showed that the physiotherapy was only effective in reducing the hypertonia measured by the Myotonometer device at week twelve for the lower limb's Gastrocnemius and Adductor Magnus muscles.

Conclusion: The result can be used in future clinical guidelines to manage spastic paralysis. Future studies should look at a series of treatments using osteopathy to improve motor function in patients with spasticity due to brain injury in large multicenter trial.