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CHAPTER 31
impulses arising from the contracted joints or tendons remain just the same and act as
strong afferent stimulus to the isolated cord, thus increasing its unrestrained activity.
Passive movements from the start are essential measures and are most effective in the
prevention and treatment of excessive spasticity. The effect of passive movements on
the relaxation of spastic muscles is increased by placing the patient in a continuous bath
of a constant warm temperature while these movements are carried out under water.
It was found that alternating passive movements of paralysed spastic legs, produced
by cycling action in a pedal exerciser worked with the arms, has a remarkably
relaxing effect on spasticity. The writer's design of such an exerciser for paraplegic
patients (Guttmann, 1949) is described in detail in the chapter on physiotherapy. The
relaxing effect of this pedal exerciser, which represents mainly a fatigue effect, lasts
several hours and in some cases even throughout the day, and this naturally gives great
relief to the spastic paraplegic patient. Thus, in accordance with Riddoch's observations
(1917) that fatigue has a depressant effect on spasticity, we utilized the fatigue effect on
the spastic patient to facilitate his activities in the wheelchair or walking in parallel
bars or on crutches. Another method to relieve spasticity is that of continuous tetanizing
of muscle groups by low voltage currents (Lee
et
a/., 1950; Vogel
et
a/., 1955). However,
this method did not become popular.
2 Utilization of postural reflexes
The effect of posture on the flexor and extensor reflex response has already been men
tioned. While, in the supine position, the flexor reflex response of hips and knees is
predominant, in the prone and upright position it is the extensor reflex synergy. Follow
ing my physiological studies in the spinal man, I have systematically used the earliest
possible standing position of paraplegics in parallel bars as a means of overcoming the
exaggerated action of the flexors of hips and knees. It was found that, with training, the
change from the flexor to the extensor synergy could be greatly accelerated, sometimes
even to such an extent that standing and walking in parallel bars without the aid of any
artificial support to the legs was possible. In high thoracic and especially cervical lesions,
the extensor synergy of the trunk and lower limbs could be greatly enhanced by placing
the patient for several hours into prone position.
3. Effect of drugs on spasticity
For many years, there has been a constant search for a drug which would have a long
lasting, relaxing peripheral effect on spasticity without having undesirable side effects
on the whole organism. From all personal observations and publications of many authors,
it can be concluded that so far such a drug does not exist. This applies to Curare (Tubo-
curarine), Myanesin (Tolserol, Mephenesin), Chlormezzanine (Trancopal), Equanil
(Metrobamate), Flexine (Zoxazolamine) and Prostigmin, the latter by mouth or intra
muscular injections (Schlessinger, 1946; Elkins & Wegner, 1946; Guttmann, 1946;
Weiss
et
a/., 1956; Carter, 1959; Ganz, 1959). Myanesin first described by Berger &
Bradley (1946) as a muscle relaxant in animals has been widely applied in past years in
