Spasticity Mgmt Flashcards
Chemical neurolysis for neuro management?
What are its advantages? Disadvantages?
Alcohol
Phenol
Lidocaine
Advantages: Reduce tone/ temporary effect
Disadvantage: temporary sensory dysthesia/permanent weakness
Chemical agents good for?
Alcohol better for hip than botox
Can change tone and decrease bony surgery (do early)
work on obutrator nerve and sciatic usually
Where do you inject Botox and what does it do?
Adv./Disadvantage?
At NMJ
Inhbits releace of Ach onset 1-3 days and peaks at 2-6 weeks. Last 3-6 mo.
Advantage: can repeat and at every muscle
Disadvantage: temporary/expensive af/limted dose/
Side effects of Botox?
Soreness
Fatigue
Temporary weakness
It has better effects in dystonia and younger kids though
Types of Baclofen?
Oral: barely cross bbb but sedates kids.
Intrathecal: for spasticity/spasm
In abs into SC and can have 3 mo supply
Need to work within window of correction to get muscle strong.
O
Complications of Baclofen?
Infection
Malfunction (can OD)
Discomfort when prone.
Ive after 4 years and greater than 35 lbs
Sideffects of Baclofen?
What happens with OD?
Lighthead/drowzy
Nausea/vomit/diarrhea/urine dysfx.
Dry mouth
Double vision
OD:
Ascending muscle weakness
Lose tone
Sleepy/ decrease respiration
What is selective post rhizotomy
Cutting abnormal sensory rootlets most responsible for abormal tone(permanent)
Used when:
they have volitional control
Spasticity interferes positioning and self care
3-6 years
CI is if they rely on spasticity for Fx
Does spasticity return after selective Rhizotomy?
What are complications and schedule after?
Yes but not great
Comp: Scoliosis/incontinent/transient parasthesia
Need PT 5x/week for 1 year and trunk ROM restricted,
Why would you use any of these chemical agents?
Reduce muscle tone/buy time/allow orthotic fit
Reveals weakness or stiff/contracture
Estim notes?
At night on innervated muscle
Get proper placement to avoid muscle ache/skin irritation
