Management of Spasticity

Question 1

Spasticity Incidence

Answer 1

Stroke: 20%
SCI: 34%
TBI: 50%
CP: >90%
MS: 47-70%

Question 2

How to Recognize Spasticity

Answer 2

-Posturing in standing/sitting
-ROM limitations
-Synergies
-chartt review
-speech
-MAS, hyperreflexia, primitive reflexes

Question 3

Spasticity Being Helpful

Answer 3

-assist with postural control
-maintain muscle mass and bone strength
-reduce edema
-prevent DVT

Question 4

Botox for Spasticity

Answer 4

-blocks acetylcholine release
-slow twitch recover fastr than fast twitch
-injected directly into msucle belly
-2-3 days to start

Contras: children, pregnancy, neuromusclular transmission disease, inflammation

Good for: localized stasticity, no cognitive deficits, ambulatory Pts, has AROM

Question 5

Medications for Spasticity

Answer 5

Baclofen, tizanidine, dantrolene, clonidine, diazepam, lidocane spray (increases H reflex)

S/e: fatigue, lethargy, cognitive deficits

Question 6

Baclofen

Answer 6

-reduces spasticity
-inhibits reflexes at SC level

Oral: reaches BBB, more s/e (black box, sedation)

Intrathecal: does not reach BBB, 1/100 of oral, less s/e, stays under skin
-more severe spasticity
-don’t need spasticity for movement
-T12-L1

Adverse Effects:
-quick withdrawl
-overdose if pump malfunctions
-respiratory depression, confusion, n/v, infection

Question 7

Nerve or Motor Point Blocks for Spasticity

Answer 7

-phenol or alcohol injected into nerve
Short term: similar to local anesthetic
Long term: protein denaturation
-lasts ~6m

Question 8

Spinal Electrical Stimulation for Spasticity

Answer 8

-dorsal column
-electrodes placed on back
-better tone management than baclofen pump

Question 9

Neurotomies for Spasticity

Answer 9

-surgery of nerve
-must keep 20% of motor fibers
-permanent

Question 10

Rhizotomy for Spasticity

Answer 10

-% of nerve rootlets are cut
-requires laminectomy/otomy
-permanent

Question 11

Tendon Release for Spasticity

Answer 11

-increases length
-hamstrings or achilles MC

-SPLATT: split anterior tib tendon transfer

Question 12

Non-Invasive Treatments for Spasticity

Answer 12

-stretch
-strength training (agonist and antagonist)
-e-stim (antagonist for reciprocal inhibition)
-EMG (suppress undesired motor patterns, promote voluntary contractions)
-temp
-casting
-meds

Question 13

Removable Casts/splints

Answer 13

-air pressure spints, foam supports, firm/orthoses

Question 14

Nonremovable Casts/splints

Answer 14

Serial Casts:
-most successful when contractures present and pt able to use exteremity
-provide warmth, decreased sensory input, prolonged stretch

Question 15

Static and Dynamic Casts

Answer 15

Static:
-casts and AFO (rigid)

Dynamic:
-dynasplins, drop out casts

Question 16

Soft and Air Filled Casts

Answer 16

Soft:
-ace wraps, foam

Air filled:
-pressure splints

Question 17

Heterotropic Ossification

Answer 17

-abnormal bone development in soft tissue (aka myositis ossificans)
-usually surrounding joints

Neurogenic:
-trauma to CNS (TBI (8-20%)), SCI (10-78%))
-more common after coma/PVS
-3-17 weeks after injury

Traumatic:
-burns, amputations, fx, dislocation, joint replacement

Presentation:
-below level of lesion (rarely peripheral joints)
-SCI: hips and knees
-TBI: hip, shoulder, elbow
-pain, inflammation, ROM
-Hardness, nerve impingement, pressure injuries, infections, fx