spasticity Flashcards
6 options for spasticity treatment
- Physiotherapy
- Spasticity clinics
- Medication
- Functional electrical stimulation/ neuromuscular electrical stimulation
- Splinting/casting
- Surgical procedures
- Physio treatment sessions:
- improve function and works toward patient goals at activity and participation level
- maintain muscle length and joint mobility
- Spasticity clinics:
MDT review and provide holistic assessment and management, long term management
* Review of aggravating extrinsic factors with appropriate referrals / signposting
* Medication reviews to ensure mediation is appropriate, maximise effects and reduce side effects
* Focal = botulinum toxin, phenol
* Systemic = baclofen, tizanidine. For more global spasticity.
* Intrathecal = baclofen, phenol. For more advanced spasticity. Inserted into spinal cord with pump.
- Medication:
- systemic (baclofen, tizanidine)
- or focal (Botulinum toxin, phenol)
- FES/NMES:
reciprocal inhibition and motor re-learning
- Splinting/casting:
serial casting, splinting and orthotics
- Surgical procedures:
tendon lengthening or transfer, selective dorsal rhizotomy
motor learning difficulties
For normal motor learning to occur, the individual must be able to perform the task – even though performance may be imperfect. With repetition, feedback of performance, motivation, encouragement etc. performance improves. Where motor control is severely limited the individual is unable to perform the task and so cannot practice effectively and often receives negative or absent feedback, they may become discouraged and de-motivated. For an individual who has one normally functioning arm and hand the temptation is strong to perform tasks one handed – with the consequent learnt disuse effect
Action of Spasticity medications
- Reduced muscle tone by acting on CNS or skeletal muscle
- Increasing inhibitory signals OR decreasing excitatory signals
- Spasticity can be useful and used to function, therefore important to control medication and ensure correct dose
How does Baclofen work?
(Systemic or Intrathecal)
- binds to GABA-B receptors to increase inhibitory effects of GABA.
- It inhibits spinal reflexes by reducing muscle spindle sensitivity.
Baclofen dosage & side effects
(Systemic or Intrathecal)
- Dose of <100mg/day.
- Side effects include: sedation, drowsiness, fatigue, reduced attention, deterioration in cognitive function
How does Tizanadine work?
(systemic)
- Impairs the release of excitatory NTM from spinal interneurons
- and increases pre-synaptic inhibition of motor neurones
Tizanadine side effects
(systemic)
- Drowsiness
- changes to bladder/bowel
- bradycardia
- hypotension
- blurred vision
- dyskinesia and hallucinations
Functional Task Practice
Importance of intensity and repetitions (dose) for neuroplasticity
* Whole vs part
* Aim is to improve function and work toward patient goals at activity and participation level
* Reduce secondary changes including contractures via WB and improved coordination
Positioning lying
modified supine or side lying with appropriate supportive aids such as pillows, wedges, T Rolls to modify supine and side lying positions.
