Shilpa Khandare et al COMPARISON OF POST 24 HOURS EFFECT OF COOLING AND SUSTAINED PASSIVE STRETCHING AS TREATMENT TECHNIQUES FOR REDUCTION OF SPASTICITY IN HEMIPLEGICS USING H-REFLEX Int J Cur Res Rev, Nov 2012 / Vol 04 (21) , Page 144 IJCRR Vol 04 issue 21 Section: Healthcare Category: Research Received on: 06/09/12 Revised on: 15/09/12 Accepted on: 26/09/12 COMPARISON OF POST 24 HOURS EFFECT OF COOLING AND SUSTAINED PASSIVE STRETCHING AS TREATMENT TECHNIQUES FOR REDUCTION OF SPASTICITY IN HEMIPLEGICS USING H-REFLEX Shilpa Khandare, Tushar J. Palekar Padmashree Dr. D.Y. Patil College of Physiotherapy, Pimpri, Pune, India E-mail of Corresponding Author: shil287@yahoo.co.in ABSTRACT Background: Studies have shown that alpha motor neurons (MN) serving skeletal muscles are hyperexcitable in presence of spasticity and can be activated by inputs that would normally evoke a response. There is activation of gamma motor neurons (gMN) for the degree of MN activation thus to analyze its effect on spasticity, H reflex is used. Various modalities are used to reduce spasticity, cooling and sustained passive stretching is two of them. Studies have been conducted to find out efficacy of each but a comparative study to find out post 24 hours effect of them has not been performed. Objectives: To find out Post 24 hours effects of application of cooling and sustained passive stretch on reduction of spasticity using H reflex and comparing the two techniques to find out which is more effective. Method: Thirty patients (male=21, female=09) were selected between the age group 40-70 years with spastic hemiplegia due to cerebrovascular accident. The average time since the onset of hemiplegia was 9.238.36 months and the patients were selected for the study from the OPD of physiotherapy department, they were divided into two groups with 15 patients in each group The affected side of the patient was considered as Study group A Cooling was given and Study group B Sustained Passive Stretching was given along with routine rehabilitation. H reflex was used as outcome measure to test spasticity in all the patients at pre and post 24hrs. Results: Our study did not find any statistically significant difference between cooling and sustained passive Stretching for reducing the hypertonicity in triceps surae muscles (p<0.05). Conclusion: It is concluded that Cooling and Sustained passive stretching both are equally effective in reducing spasticity of tricep surae muscles in patient with hemiplegia. Key words: Spasticity, Cooling, Sustained Passive Stretching, H-reflex. INTRODUCTION The Global Burden of disease study described a measure that integrates the sum of life-year lost due to premature mortality and year lived with disability adjusted for severity, the so-called disability –adjusted life years (DALY). In 1999 cerebrovascular disease accounted for 50 million DALY worldwide, representing 3.5% of all DALY 1,2 . Projection to year 2020 show that 61 million DALY are likely to be lost due to cerebrovascular disease each year, and of these 52 million (84%) will be in the developing country. The global population aged over 65 year is increasing by 9 million a year. By 2025 there will be more than 800 million people over 65 year of age in the world; two-third of them will be living in developing countries. Many people had to live with disability developed with spasticity 3 . Jun Kimura (1983) 4 reported that direct evaluation of tone is subjective and erroneous, thus an indirect method using H reflex can be used. They considered the amplitude of H and M and a ratio