Neurological Management (Spasticity)

Question 1

Chemical neurolysis must be within ____ of nerve/motor end point. List 3 chemicals used to perform neurolysis.

Answer 1

1mm of nerve/motor end point

1. Alcohol (50% concentration; less effect by 3rd injection)
2. Phenol (2-8% concentration)
3. Lidocaine (short acting)

Question 2

List 2 advantages of using chemical agents to treat spasticity.

Answer 2

1. Reduction in tone

2. Temporary effect (nerve will restore itself over time)

Question 3

List 2 disadvantages of using chemical agents to treat spasticity.

Answer 3

1. Temporary sensory dysthesias

2. Permanent weakness

Question 4

Chemical agents lose their effect secondary to ______ of the nerve.

Answer 4

Distal regeneration of the nerve

Question 5

_______ is better at treating spasticity at the hip than Botox.

Answer 5

Alcohol

Question 6

List 5 nerves for which chemical agents are injected.

Answer 6

1. Common obturator
2. Less common tibial
3. Femoral
4. Sciatic
5. Musculocutaneous

Question 7

Botox is injected at the ______ and diffuses ____ from the injection site.

Answer 7

Injected at the NEUROMUSCULAR JUNCTION

Diffuses 4-5cm from injection site

Question 8

Botox inhibits the release of _____.

Answer 8

Acetylcholine

Question 9

What is the onset and peak effect of Botox? How long does it last?

Answer 9

Onset = 1-3 days
Peak effect = 2-6 weeks
Lasts 3-6 moths

Question 10

List 2 advantages of Botox.

Answer 10

1. Repeatable

2. Versatile (can be done at every muscle)

Question 11

List 3 disadvantages of Botox.

Answer 11

1. Temporary
2. Limited dosage
3. Expensive

Question 12

List 3 side effects of Botox.

Answer 12

1. Local soreness
2. Transient generalized fatigue
3. Temporary weakness

Question 13

Describe 2 types of baclofen.

Answer 13

1. Oral = mild effect and limited crossing of BB

2. Intrathecal = can hold up to 3 months supply

Question 14

List 3 complications of intrathecal Baclofen.

Answer 14

1. Infection
2. Malfunction
3. Discomfort with lying on stomach

Question 15

Children must be older than ___ years and weight more than _____ lbs to receive Baclofen.

Answer 15

Older than 4 years

More than 35lbs

Question 16

List 6 side effects of Baclofen.

Answer 16

1. Lightheadedness
2. Drowsiness
3. Double vision
4. Dry mouth
5. Diarrhea/urinary dysfunction
6. Nausea/Vomiting

Question 17

List 3 signs of a Baclofen overdose.

Answer 17

1. Ascending muscle weakness
2. Loss of tone
3. Sleepiness/breathing depression progressing to coma/respiratory arrest

Question 18

Selective posterior rhizotomy involves cutting abnormal ______.

Answer 18

Sensory rootlets

Question 19

List 3 indications and 1 contraindication for selective posterior rhizotomy.

Answer 19

Indications

1. Have sufficient volitional control
2. Spasticity interferes with positioning and self care or causes discomfort
3. Preferred age 3-6 years

Contraindication = rely on spasticity for function

Question 20

List 3 complications of selective dorsal rhizotomy.

Answer 20

1. Scoliosis
2. Bladder incontinence
3. Transient parathesias

Question 21

Children who undergo selected posterior rhizotomy receive PT ____ time per week for ____.

Answer 21

5x/week for 1 year

Question 22

TENS must be done at _____ and the muscle must be _____.

Answer 22

Done at night

Muscle must be INNERVATED