Spasticity Management

Question 1

Loss of Length LMNL

Answer 1

loss of muscle function

will shorten and atrophy if left in position for too long = contracture

Question 2

Management loss of length LMNL

Answer 2

manual stretching/passive movements through joint ROM
prolonged stretching 30mins +
position the joint to prevent shortening
splinting/casting to keep muscle lengthened
surgical tendon lengthening

Question 3

Spasticity - facilitatory techniques

Answer 3

Want to excite the muscle to help elicit a contraction 
Methods 
- electrical stimulation 
- suspension therapy 
- quick stretch 
- approximation/compression 
- ice
- guided/graded resistance 
- rhythmic stabilisation

Question 4

Spasticity - electrical stimulation

Answer 4

most effective methods of eliciting a contraction if the muscle still has nerve supply
Useful for 1st stage motor recovery - flaccidity

Question 5

Spasticity - suspension therapy

Answer 5

eliminates gravity/friction so that the weak muscle can contract through available ROM
Useful for stages 2-4

Question 6

Spasticity - quick stretch

Answer 6

Lengthen the muscle/tap muscle belly to target stretch receptors
Assist in muscle contraction of the agonist and reciprocal inhibition of the antagonist

Question 7

Spasticity - approximation/compression

Answer 7

compress the joint surface to activate the joint and muscle proprioceptors

Question 8

Spasticity - ice

Answer 8

apply briefly to muscle belly - activates the cold and pain receptors to raise excitability of stretch receptors and spinal motor neurons

Question 9

Spasticity - guided/graded resistance

Answer 9

Direction specific manual resistance - enhances muscle contraction and facilitates muscle synergies

Question 10

Spasticity - rhythmic stabilisation

Answer 10

Apply maximal resistance to opposing muscle groups in an alternating fashion - produces maximal state contraction in postural muscles in order to promote stability

Question 11

Spasticity - Inhibitory Techniques

Answer 11

Attempt to reduced hyper-excitability of the muscle which would lead to muscle stiffness

Question 12

Spasticity - Inhibition via medical management

Answer 12

Baclofen - systemic medication. Acts on the receptors in the brain and spinal cord to reduce abnormal muscle tone. Injected straight into spinal fluid, can have sedatory effect

Botulinum Toxin - focal intervention. Prevent muscle contraction, lasts for 3 months but most effective in first 6-8 weeks post injection

Question 13

Spasticity - Inhibition via non-medical management

Answer 13

Identify and remove any spasticity triggers (pain, pressure, anxiety, infection etc.)
Position the muscle in a lengthened position for prolonged period of time (at least 6 hours a day_
Monitor severity of muscle overactivity
Educate the patient
Repeated passive muscle lengthening through ROM
Strengthen agonists
Use serial casting/splints if indicated