CASE REPORT, REFLEXOLOGY AND FOCAL MYELOPATHY AND MYELOMALACIA

Psatha A., Karamichali E., Dr med Mouzarou A. Universal Studies of Health and Business, Athens Greece

LOGO

CASE PRESENTATION Male 58 ypres old presented with difficulty in walking due to gait impairment and numbness in both legs, especially at the big toes. Moreover, patient referred tremor in both legs and fatigue. In May 1998, patient presents difficulty in walking, tremor and numbness at lower limbs, symptoms that aggravate in the course of time. In September 1998, he visits a neurosurgeon and after taking a MRI, his evaluation was cervical disk herniation with myelopathy. Neurosurgeon proposed immediate surgical treatment. After the surgery patient presents appreciable reduction of the symptoms. August of 2009, patient presents deterioration of his symptoms. He visits the same neurosurgeon that operated him before, who proposed a MRI. The diagnosis was: A3-A4: backward prolapsed disc with intense pressure on the spinal cord. 4-5: collapse of the intervertebral space with posterolateral osteophyte and intense pressure on the subarachnoid space without pressure at the spinal cord. At this point MRI indicates myelopathy with gliosis figures (myelomalacia). (MRI findings) Clinical features Local symptoms in the cervical spine (neck): pain, nuchal rigidity, limited movement, muscle spasm and local tenderness in paravertebral pressure. Medullary symptoms: muscular weakness in the legs, hyperreflexia, positive Babinski and Hoffman, intense tremor of lower limbs. The patient is not able to run, and he walks with difficulty and with open legs due to instability. The doctor proposed surgical treatment. Patients demand was to follow a conservative treatment for his problem.

RESULTS

Patient was examined by a neurosurgeon independently of us and he suggested immediate surgical intervention for his myelopathy. His reflexology treatment began on 24/11/09 and ended on 25/11/10 with very interesting outcomes. There were 11 sessions over 12 weeks. According to the measurements done and patient statements all his symptoms were improved. From the graph, clearly arises the improvement of the symptoms, listed on therapeutic goals. The small aggravation is due to the early reduction of sessions frequency. Gait impairment and tremor in both legs present more deflation than numbness, which remained almost stable.

Measurement/+ Numbness+ No+of+session+ st st 1 +/1 session+ 3,5cm+ nd th 2 +/4 session+ 3,8cm+ rd th 3 +/8 session+ 3cm+ th th 4 +/11 session+ 2,5+cm+ + + + + +

Tremor+ 6,2cm+ 1,2cm+ 1,1cm+ 2,8cm+

Gait+ impairment+ 8,5cm+ 3,3cm+ 2,9cm+ 2,6cm+

METHODS & MATERIALS

Reflexology is a complementary method of treatment which according to WHO belongs in traditional healing methods (empirical therapy). Reflexology is based on the theory of zone-reflexology of Dr. Fitzgerald and uses the maps of Ingham. These theories state that there are reflex points of the body, on feet, hands and ears. Pressure using various techniques (alternative pressure, stable pressure, caterpillar pressure, circular pressure, rolling and tipping) applied with the fingers and hands, is believed to create a signal. The nature of the signal is yet to be proven. The suggested session lasts from 45 to 60 minutes maximum, with a frequency of 10-12 sessions over 8-10 weeks period. Treatment plan The therapeutic design was focused on reducing the major symptoms: 1. reduction of numbness in right leg 2. improvement in walking 3. reduce the tremor of lower limbs 4. a general relaxation of the body. The progress was measured by a 10 cm symptom scale.(fig 1)

!
DISCUSSION
In general radiculopathy symptoms in most of the cases are manageable, but myelopathy symptoms are resistant in most of the curative methods. Therefore this case, is about a non awaited result, since the patient refers to improvement of gait and tremor 12 weeks after the first evaluation. Patient had already undergo an operation in the past (1998), for the same reason, with an efficient results (improvement but not extinction of the symptoms) Therefore, before proceeding to a second operation, he preferred to try a non invasive treatment. Due to his intense fatigue and weakness, he did not follow regular physiotherapy and kinesiotherapy. After taking the advice of an expert we decided to accept this case, and initially we focused on the stability of the symptoms. Nevertheless, after 12 weeks of treatment, patient presented the proreported improvement. It appears that with reflexology patient achieved or almost achieved the same result that he had after the 1st operation.

! ! ! foot!
Fig. 1, 10cm line, used as a symptom scale

!!!!!!!!!Reflex!points! hand!

Pituitary!gland,! all!the!zones!from!elbow! hypothalamus,!bladder,! to!wrist,!the!zones!of!the! kidney,!adrenal!glands,! intestines,!head!and! vertebral!column! vertebral!column! (especially!cervical!spine),! (especially!cervical!spine)! 5th!zone!of!the!feet!and! the!reflex!points!of!the! legs! !

CONCLUSION

Focal myelopathy and myelomalacia can cause severe functional problems to the patients suffering from it. Symptoms may vary in intensity and duration. Reflexology might consists a therapeutic approach, under medical supervision, in non -operable cases.