Evidence Based Practice - Spasticity Flashcards
Why should 24 hour posture management be used and how?
Prevention of STS and contractures
Improves extensibility of tissues
Use of pillows and supports
What is a prolongued stretch? How to apply? What is the effect?
Stretch for 20-30 minutes through splints or casting
Increases extensibility of tissues and provides viscoelastic changes to the soft tissues
How can tone be modulated in spasticity?
Rotational movements, TENS, Weight-bearing and FES
Causes input via the vestibular system which increases the descending inhibition
What is a manual stretch and when should it be applied?
20-30s holds, complete prior to and during exercise to increase extensibility
Start as a passive stretch - then progress to active stretches and task-specific stretches
What should be avoided with spasticity?
Noxious stimuli
High velocity movements
Why should exercises include dynamic aROM?
Prevent STS and minimise loss of movement
What kind of principles can be applied for dynamic aROM exercises?
- Slow and controlled active movements
- Decrease friction to make it easier
- Funcitonal exercises
What are the medical management options for spasticity?
- Spinal cord injections of baclofen or phenol
- Oral medications to block excitation in ascending or descending tracts - e.g. baclofen or gabapentin
- Surgical tendon release
What type of outcome measure is goniometry?
impairment-based to show STS
What is the validity of goniometry?
Poor inter-rater validity due to palpation of bony points, and lack of stabilisation when goniometry is placed
What is the reliability of goniometry?
Consistency of results can vary but improved by:
- same goniometer
- positioning
- procedure
- tester
When to complete goniometry?
Repeat before and after the physio session once a month
