SCIATIC NERVE BLOCK FOR GAIT DISTURBANCE OF SPASTIC HEMIPLEGIA

Abstract

We report a case of spastic hemiplegia with excessive synergy of the left lower limb, for which a sciatic nerve block was effective. The patient was a 57-year-old female, who had subarachnoid hemorrhage followed by cerebral infarction, and was admitted to our hospital for the purpose of rehabilitation five months after the onset. Left unilateral spatial neglect and left hemiplegia were observed. Synergy from extreme spasticity was also observed, which hindered the extention of the left lower limb. As neither physical therapy nor pharmacological approach produced any effect, a sciatic nerve block by a local anesthetic (1 % lidocaine hydrochloride 10 ml) was tried once or twice a week for a total of 10 times. Spasticity of the hamstrings decreased gradually and the knee extensor muscles started to contract. The power and the movement of the lower limb improved and the subject began to walk again. Improvement of the left lower limb was because of the following: . The nerve block temporarily relaxed the knee extensor muscles and removed reciprocal inhibition. The experience of muscle contraction under such a condition expanded the possibility of lower limb movement. On the other hand, contraction of the extensor muscles produced reciprocal inhibition against the hamstrings, decreasing the spasticity. Thus, the subject was able to walk.