Week 4.8 Spasticity management 2 Flashcards
what is the most common oral mediation for TBI and SCI
baclofen
what are the side effects of baclofen
horsiness, dizziness and weakness
what are the cons of oral medications
effects ebb and flow
must take on a schedule
sedating side effects must ween off
what are some of the pros of oral medications
non-invasive
non-permeant
effective management or positive signs
inexpensive
the clinical usefulness of oral medications are limited by
side effects
do oral meds have a lot of high evidence,
no
we choose medications based on…
side effect profiles
should oral meds be the first line of treatment
no
what is chemical neurolysis:
phenol or alcohol applied to the nerve via injection with EMG guidance. causes demyelination of the axon, and can last up to 6 months.
what is a neuromuscular blockade
Botox, injected into the, muscles, binds to presynaptic cholinergic nerve terminal and blocks the release of ACH
what are the advantages of chemical neurolysis
better effect on larger muscles and the cost is minimal
what are the disadvantages of chemical neurolysis
difficult procedures, risk of sensory complications, muscles become fibrotic after many injections.
what are the advantages of neuromuscular blockade
less painful easier to perform, no sensory side effects, and not permanent.
what are the disadvantages of neuromuscular blockage
only reinfect every 3 months, not permanent, cost and you might develop antibodies
what is an intrathecal baclofen (ITB)
right into the SC, much less medications
how does and ITB work
baclofen is diffused into the CSF in the intrathecal space, there is a catheter attached to the pump
mechanism of action of the ITB
presynaptic inhibition, GABA b receptor agonist
What kind of reflexes does the ITB inhibit
mono and polysynaptic reflexes.
what are the advantages of ITB
reversible, easy to titrate, fewer side effects, impoverished function and ease of care
what are the disadvantages of ITB
mechanical complication, and you need refills every 3 months and its costly.
what is the benefits of the ITB for post–stroke hypertonia
improved FIM, SIP, AS, no adverse effect on strength in unaffected limbs.
what is the ITB CPG
for those who did not respond or tolerate other interventions, can use them 3-6 months after stroke. you need the optimal dosage.
compare intrathecal with oral
intrathecal: lower dose needed and less side effects
Oral: low blood brain barrier penetration, high systemic absorption and low CNS absorption, lack of preferential distribution in the SC, adverse effects: sedation
what kind of orthopedic surgeries can we do for soft tissue
selective percutaneous myofascial lengthening,
lengthening
tendon release or transfers.
what are some skeletal procedures we can do
osteotomies and fusions
what neurological interventions can we do
selective dorsal rhizotomy, with selective destruction of problematic nerve roots (spastic roots), and lesioned.
what are general and reversible management things for spasticity
oral therapy and ITB
what are general and permanent managements
SDR
Reversible and focal
BTX-A
permanent and focal
surgery
what can we use to treat focal spasticity in MS
BoNT-A and exercise,
review paper of rehab procedures in spasticity management showed the integration of…
meds and rehab
rehab therapies after BoNT-A for limb spasticity
ergometer cycling, E-STIM, CIMT, task specific motor earning and exercise programs with the BoNT-A.
what assumption do we make about spasticity and what does this mean
assume that spasticity is a direct cause of disordered movement,, an we assess it in resting limbs, and associate it with movement disorders.
is there a direct causation between spasticity and function
no
what can we manipulate when treating spasticity
task and enviro to make the demands less,
biomechanical constraints of the individual and decrease the DOF
how can diagnose spasticity vs. MSK Contracture
tardieu scale, end feels, lidocaine block and an eval under anesthesia
what must be treated prior to surgical interventions for contractions.
spasticity
