Therapeutic Consideration for Medical/Surgical Management of Movement Disorder Flashcards
What is the order from how compensation can lead to a deformity
Compensation –> Habit –> Contracture –> Deformity
When making a decision on medical and surgical management what are some things to keep in mind?
- Patient centered
- Multidisciplinary approach
What is medical and surgical management based on?
- Function/limitation of function
- Pain
What are some spasticity management options?
- Pharmacological management
- Selective Dorsal Rhizotomy
- Others in specific movement disorders (Stereotactic Neurosurgery & Deep Brain Stimulation)
What is the purpose of anti spasticity /Skeletal muscle relaxants?
Decrease tone & control involuntary movements
What are the central acting pharmacological management of movement disorders?
- Baclofen (Lioresal)
- DIazepam (Valium)
How is Baclofen administrated?
- Oral
- Continuous Intrathecal Baclofen Infusion (CIBI)
How does continuous intrathecal baclofen infusion work?
- Intrathecal delivery with implanted pump
- Small catheter implanted surgically into subarachnoid space at specific area of cord
- Programmable pump implanted subcutaneously in abdominal area, programmed to deliver slow/continuous amounts of drug
T/F: Antispasticity/Skeletal muscle relaxants are not direct acting on skeletal muscle
False they are
- Dantrolene Sodium (Dantrium)
Where are motor point blocks/nerve blocks injected?
6% solution of (phenol) alcohol injected into motor point of muscle or peripheral nerve –> Neurolysis
How long does motor point blocks/nerve blocks decrease tone for?
Lasting 3-6 months
What is the negative to motor point blocks/nerve blocks?
Sometime difficult to get motor without sensory
What is the mechanism of Botulinum Toxin?
Binds to acetylcholine vesicles at NM junction and interrupts synaptic activity
Where is Botulinum Toxin injected and when does relaxation occur?
- Injected into muscles
- Relaxation in several days
What is the benefit and con of Botulinum Toxin?
- Benefit: May help to delay surgery or decrease number of surgical procedures
- Con: May require re injection
What is Transdermal Clonidine and how is it administered?
- Muscle relaxant
- Administered: via patch
How can antiepileptic drug be used for movement disorder?
May block random firing of neurons
What is the implications of a PT in concerns to Botox?
- Timing of intervention
- Adjuncts to botox
What are some neurosurgical management of movement disorders?
- Neurectomy (partial or complete)
- Myelotomy
- Localized cordectomy
- Selective Dorsal Rhizotomy (SDR)
What is a myelotomy?
Severance of spinal cord nerve fibers
What is a localized cordectomy?
Severance and removal of tissue from cord
How is a selective dorsal rhizotomy performed?
Surgical reduction of input from sensory fibers
What is the criteria to select the patient for selective dorsal rhizotomy?
- Male 3-14 y/o & Female 3-12 y/o
- No severe contractures, weakness secondary to multiple orthopedic procedures, additional disorders, severe scoliosis or TBI
- Age appropriately cognitively
- Family compliance
- Availability of intensive post op PT
What are some PT treatments post Rhizotomy?
- Muscle stretching to gain joint mobility & range
- Muscle strengthening to increase endurance
- Muscle reeducation to impart a better pattern of muscle use
