Comparison of Physiotherapy Methods Using Hereditary Spastic Spinal Paralysis (HSP) as Example


This investigation is being carried out within the scope of a doctoral dissertation at the Humboldt University in Berlin and is overseen by Prof. Dr. Mueller – Fahrnow. The dissertation concerns the core symptomatology of the spastic from the point of view of physiotherapy and compares different physiotherapy methods with each other. In so doing, the question of what experiences the patients have had with the different physiotherapeutic interventions, and whether any other control mechanisms play a role, forms the central core of the dissertation.

This question will be pursued by means of an investigation carried out with a telephone questionnaire directed at an hereditary spastic spinal paralysis patient group as an example. In this work, the scientifically recognized methods of treatment methods for reducing spastic "Bobath", "PNF" (proprioceptive neuromuscular facilitation) and "Vojta" will be compared with each other.

The relative importance of this investigation is considerable, since in the field of physiotherapy up until now, only the effectiveness of the individual methods was shown, but no study has yet concerned itself with the comparability of the individual physiotherapeutic treatment methods.

Based on the assumption that the Bobath concept is not just limited in time while the therapy unit takes place, but also represents a constant element of the entire daily routine, it can be gathered that the "long term effect" of this form of therapy is more effective than the treatment according to Vojta or according to the proprioceptive neuromuscular facilitation method.

If this dissertation can prove that a sustained reduction of spastic can be better achieved through one physiotherapeutic method than through other physiotherapeutic methods, then in the future, this aspect can be considered in the doctor’s choice of prescriptions, thereby increasing the quality of life of the affected patient group. Whereby the term, quality of life, means not only the subjective feeling of relief, but also the patient’s independence in daily life or the ability to continue working.

If it is possible to support a patient’s self-reliance longer through effective physiotherapeutic treatment, then the savings to the health insurance in the long run in regard to nursing care is an important economical factor.

First of all, the clinical picture of spastic spinal paralysis will be presented in order to create a basis for understanding this illness. Hereby, the symptomatology of the illness will be represented, since the physiotherapy methods only have influence over the symptoms.

The molecular genetics basis will only be referred to; this causal problem is being investigated in various research projects.

Likewise, the medicinal therapy possibility will be examined only briefly; a series of research studies also exists for this problem area.

Associated with this is the problem analysis of the physiotherapeutic objective, which registers and describes the symptoms to be treated. This symptom register serves as the basis for the drawing up of the investigation questionnaire, as well as for the deduction of the enquiry hypotheses which are recorded by the questionnaire to be developed.

The investigation is carried out on a group of patients who exhibit the symptoms of "HSP," since here the symptomatic is clearly outlined, with the main characteristic of slow progressive paraspastic. The gait of these patients has already been scientifically analysed so that these insights can be fallen back upon.

Since this clinical picture involves a relatively rare genetically-caused illness, no "HSP Centre" exists in Germany or Europe, however, the Tom Wahlig Foundation in Muenster has made it its business to gather the research results of various investigations in regard to HSP and to offer this patient group at all levels a forum. Therefore, it is possible to carry out a study with an adequate number of patients.

The investigation is to be carried out based on a "case control study." This involves a very popular research design in the field of medicine used to interpret current findings retrospectively.

A structured telephone interview is to be carried out with the patients in order to collect questions regarding their behaviour after receiving the diagnosis. Especially the motives for the commencement of a certain physiotherapeutic measure are to be enquired about, as well as assessment of the therapy during the course of the illness in regard to its effect on maintaining the ability to work or the activities of daily life.

In addition, questions from the SWE questionnaire are to be used to gather the general self-effectiveness expectation of the patients, since a close connection to the choice of physiotherapeutic methods is expected here.

Ilse-Dore Strobel, Potsdam