Chapter 26 Spasticity Flashcards
Spasticity is a disorder characterized by a __________ increased resistance to __________ stretch, associated with exaggerated tendon jerks, resulting from hyperexcitability of the __________. Spasticity is part of the __________ syndrome, which includes the positive symptoms of spasticity and uninhibited flexor reflexes in the lower limbs and the negative symptoms of weakness and poor dexterity.
Spasticity is a disorder characterized by a velocity-dependent increased resistance to passive stretch, associated with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex. Spasticity is part of the UMN syndrome, which includes the positive symptoms of spasticity and uninhibited flexor reflexes in the lower limbs and the negative symptoms of weakness and poor dexterity.
Indications for treating spasticity include ______, decreased function, ______, skin breakdown, poor cosmesis, and poor positioning.
Indications for treating spasticity include pain, decreased function, poor hygiene, skin breakdown, poor cosmesis, and poor positioning.
Potential factors that may be exacerbating spasticity (e.g., ______, ______, bowel impaction, ingrown toenails, and ______) should be addressed.
Potential factors that may be exacerbating spasticity (e.g., pressure ulcers, UTIs, bowel impaction, ingrown toenails, and SSRIs) should be addressed.
Care should be taken before treating any spasticity that may be utilized functionally (e.g., __________).
Care should be taken before treating any spasticity that may be utilized functionally (e.g., hypertonia in the lower limbs assisting transfers or gait).
A _______ program should be the cornerstone for most spasticity treatment programs. _______, _______, or bracing can help preserve ROM by “resetting the _______.”
A stretching program should be the cornerstone for most spasticity treatment programs. Splints, casting, or bracing can help preserve ROM by “resetting the muscle spindles.”
Contractures can be reduced by ________ a joint (i.e., increasing the stretch stepwise for 1 to 2 days at a time), although this technique is not always well-tolerated and may lead to _______.
Contractures can be reduced by serially casting a joint (i.e., increasing the stretch stepwise for 1 to 2 days at a time), although this technique is not always well-tolerated and may lead to skin breakdown.
___________ (>15 minutes) may be helpful transiently by reducing the hyperexcitability of the muscle stretch reflex and reducing nerve conduction velocities.
Cryotherapy (>15 minutes) may be helpful transiently by reducing the hyperexcitability of the muscle stretch reflex and reducing nerve conduction velocities.
___________ (>15 minutes) can improve function and reduce tone for hours after the _________ (thought to be due to neurotransmitter modulation at the spinal cord level).
Functional electrical stimulation (>15 minutes) can improve function and reduce tone for hours after the stimulation (thought to be due to neurotransmitter modulation at the spinal cord level).
Hippotherapy, which involves ________ movements, is found useful in spasticity reduction in ________ limbs.
Hippotherapy, which involves rhythmic movements, is found useful in spasticity reduction in lower limbs.
In treating spasticity, Other modalities include application of _______, cold, warmth, vibration, massage, low-power laser, and acupuncture.
Other modalities include application of tendon pressure, cold, warmth, vibration, massage, low-power laser, and acupuncture.
Oral Medications – These may be indicated for ________ spasticity.
Oral Medications – These may be indicated for nonfocal spasticity.
FDA-approved medications include _______, _______, _______ (clonidine), and tizanidine. Recently, offlabel use of _______ has shown promising results in the treatment of spasticity in a small group of MS patients undergoing a crossover study.
FDA-approved medications include baclofen, diazepam, dantrolene (clonidine), and tizanidine. Recently, offlabel use of gabapentin has shown promising results in the treatment of spasticity in a small group of MS patients undergoing a crossover study.
Botulinum Toxin-A (BTX-A) – BTX irreversibly blocks _________ by _________. BTX-A (Botox and Allergan) is FDA-approved for _________, _________, and _________ and most recently for severe glabellar (between the eyebrows) frown lines. It is also widely used for spasticity and myofascial pain with favorable results. Onset of effect is typically _________ hours. Peak effect is at _________ weeks. Clinical efficacy is typically up to _________ months. Recovery is due to _________.
Botulinum Toxin-A (BTX-A) – BTX irreversibly blocks NMJ transmission by inhibiting presynaptic ACh release. BTX-A (Botox and Allergan) is FDA-approved for blepharospasm, strabismus, and cervical dystonia and most recently for severe glabellar (between the eyebrows) frown lines. It is also widely used for spasticity and myofascial pain with favorable results. Onset of effect is typically 24 to 72 hours. Peak effect is at 2 to 6 weeks. Clinical efficacy is typically up to 3 to 4 months. Recovery is due to axonal sprouting.
Advantages of BTX-A over phenol include _________ into the injected area (up to 3 to 4 cm), making injections technically easier, and the absence of _________ (since it is selective for the NMJ)
Advantages of BTX-A over phenol include ready diffusion into the injected area (up to 3 to 4 cm), making injections technically easier, and the absence of dysesthesias (since it is selective for the NMJ)
BTX-B (Myobloc) – BTX-B was FDA-approved in 2000 for _________. Clinically, it is used for similar indications as BTX-A, although the units are markedly different (initially, 2,500 to 5,000 U of BTX-B divided among the affected muscles). BTX-B may be effective in patients who have _________ due to repeated use.
BTX-B (Myobloc) – BTX-B was FDA-approved in 2000 for cervical dystonia. Clinically, it is used for similar indications as BTX-A, although the units are markedly different (initially, 2,500 to 5,000 U of BTX-B divided among the affected muscles). BTX-B may be effective in patients who have developed resistance to BTX-A due to repeated use.