The Hereditary Spastic Paraparesis (HSP) or Strumpell-Lorrain disease is a heterogeneous neurodegenerative disease of the spinal cord. It is genetically transmitted and characterized by a progressive muscle weakness, spasticity of the lower limbs and awkward gain. There is no specific pharmacological treatment. The pharmacological therapy decreases the muscle tone and prevents stiffening). Physiotherapy restrains the progression of muscle atrophy, delays contraction of the tendons and gives greater mobility to people affected by the disease. The aim of this study is to demonstrate the efficacy of the combined treatment Fkt and Btx-A in patients with HSP. Retrospective study was conducted recruiting ten patients with spasticity according to Asworth modified scale of at least 2 and with gait deficit. They received treatment for 5 years with incobotulinumtoxinA and physiokinesiotherapy for addressing spasticity in the lower limbs. We evaluated muscle tone with miometric measurement both at the first visit (T0), and at subsequent ones (T1 after 30 days, T2 after 3 months from the first infiltration, T3 after 4 months up to the date of the following infiltration, T4 after 5 months). Baropodometric examination has proven essential for the study of the distribution of loads in statics and dynamics. The data analysis regarding tone assessment through measurements with Myoton highlighted hypertonus reduction in all the three muscle groups examined at T1 and the maintenance of constant values up to 5 months after the first infiltration. It also showed an increase in the percentage of back foot loading in both feet up to T4 (new inoculation, p<0, 05%). Baropodometric examination in dynamics (in particular the speed of the step) showed a gradual increase in this parameter which reaches a peak at 5 months (p<0, 05%) and then declines again in conjunction with the next infiltration treatment. This study showed the benefit of combined treatment with Btx and Fkt. The use of a local muscle relaxant drug with a physical targeted exercise guarantees better mobility of the treated segments, reducing tendon retractions as much as possible, and guarantees an adequate postural alignment. Baropodometric examination highlights a more advantageous distribution load, quite essential for avoiding tendinitis due to overload. Our data observation in the 5 years study shows how the curve relative to the speed of step and the graphics related to the variations of muscle tone remain almost constant with detectable improvement.

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Introduction: Spasticity is the most important problem in the recovery of a satisfactory function of the upper limb to the patient outcomes of cerebral stroke. Objective of the study is to compare the results in functional recovery in patients treated with botulinum toxin A and occupational therapy and patients treated with botulinumtoxinA, occupational therapy (OT) and functional electrical stimulation (FES) (Ness H-200).Materials and methods: 36 patients (middle aged 55,25±6,5) with spasticity of the upper limbs for more than six months and in particular with the involvement of the muscles of the hand. Patients were divided into two groups: Group I underwent botulinumtoxinA-occupational therapy-functional electrical stimulation, Group II underwent botuli-numtoxinA and occupational therapy. All patients were evaluated with the modified Ashworth scale, with the measurement of the passive ROM, the evaluation of the amplitude of the compound action potential of the median nerve (registration site in the flexor digitorum superficial) and ARAT test at the time T0 (recruitment and infiltration), T1 (20 days after first infiltration), T2 (3 months after first infiltration), T3 (four months after first infiltration; we reinjected botulinumtoxinA), T4 (20 days after second infiltration), T5 (3 months after second infiltration), T6 ( four months after first infiltration; we reinjected botulinum toxin A).Result: Group treated with botulinumtoxinA-OT-FES showed a statistically significant improvement compared to the other group in the evaluation of the passive ROM, in the assessment of spasticity with the modified Ashworth scale, in the reduction of the amplitude cMAP of the median nerve and in the score of ARAT test. Conclusions:The application of the FES joined to treatment with botulinumtoxinA and OT proves effective synergy for greater functional recovery of the upper limb and the best possible outcomes.