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Effective Spasticity
Management Requires a
Team Approach
Effective
spasticity management
can be a challenge
for a patient's healthcare
team. Case managers
(medical and vocational)
and life care planners
need to be aware of
the variety of spasticity
treatment options for
optimal functioning
of patients with spasticity.
Spasticity may be
seen in patients
with the following
pathologies:
- Spinal Cord Injury
- Multiple sclerosis
- Stroke
- Cerebral Palsy
- Traumatic Brain
Injury
- Other Neurodegenerative
Diseases
The incidence of
spasticity is not
certain; however,
it likely affects
half a million people
in the United States
and over twelve million
people worldwide.5
Ongoing patient
evaluation and assessment
may include one or
more of the following
common clinical rating
scales: 4
- Original Ashworth
Scale
- Modified Ashworth
Scale
- Spasm Frequency
Scale
- Global Pain Scale
- Medical Research
Council Motor Testing
Scale
- Adductor Tone
Rating
The goals of the
patient and caregiver
are vital. Before
treatment is initiated,
the following should
be considered: 5
Does the patient
need treatment? What
are the goals of
treatment? What is
the commitment of
the patient and caregivers
to the treatment?
An objective of
spasticity treatment
is not only to reduce
treatment but rather
include specific
functional objective
in the management
of spasticity.5 The
strategies are aimed
at:
- Improving mobility:
ambulation, transfers,
and wheelchair
mobility
- Improving ADL's:
dressing and hygiene
- Maximize pain
relief
- Improve ease
of care
- Maintain skin
integrity
- Optimize ROM,
tone, and outcomes
of PT/OT treatment
- Reduce spasms
for improved sleep
patterns
- Enhance oral/motor
skills and speech
- Maintain employability
- Maximize learning
for school age
patients
Spasticity does
not always require
treatment; however,
when it does, a range
of therapeutic options
is available.2,3,5 Options
may include one or
more of the following:
- Reduction of
precipitating noxious
stimuli
- Traditional physical
medicine and rehabilitation
therapeutic exercise
thermal agents
electrical stimulation
biofeedback
- Pharmacological
Management oral
medications botulinum
toxin injections
phenol and alcohol
blocks intrathecal
Baclofen
- Surgery Orthopedic:
tendon transfers,
musculotendinous
lengthening, or
joint fusions Neurosurgery:
DREZotomy, selective
dorsal rhizotomy
Case managers need
to know the modes
of spasticity inhibition,
clinical effectiveness,
as well as the adverse
effects of the various
treatment options.
Treatment objectives
need to be monitored
for treatment effectiveness.
Follow-up care is
necessary to maximize
treatment effectiveness.
Adjunct physical
therapy and occupational
therapy1 is
necessary for:
- Mobility training:
transfers, gait,
and wheelchair
- Therapeutic exercises
for both stretching
and strengthening
- Patient and caregiver
education
- Reassessment
of adaptive equipment
needs, including
seating, bathroom,
standing, assistive
technology, and
augmentative communication
- Modification
of orthotics
- Recommendation
of positioning
devices to maintain
ROM
In summary, effective
spasticity management
for improved functional
outcomes requires
a team effort, thorough
patient education,
proper treatment
selection, and follow-up
monitoring and rehabilitation.
RESOURCES
- Albany, K. "Physical
Therapy and Occupational
Therapy In Adult
Patients Receiving
Botulinum Toxin
Injections For
Spasticity". Muscle
and Nerve, Supplement
6, 1997
- Brin, M. "Botulinum
Toxin: Chemistry,
Pharmacology, Toxicity,
and Immunology." Muscle
and Nerve, Supplement
6, 1997.
- Gracies, J.,
Elovic, E., Maguire,
J., Simpson, D. "Traditional
Pharmacological
Treatments for
Spasticity. Part
1: Local Treatments".
Muscle and Nerve,
Supplement 6, 1997.
- "Spasticity Examination
Rating Scales and
Office Data Form." www.WeMove.Org
- Vanek, Z. "Spasticity". www.emedicine.com/neuro/topic706.htm June
20, 2002
LINKS
www.WeMove.org
www.nationalmssociety.org/sourcebook-spasticity.asp
Consider the addition
of Rehabilitation
Advisors, Inc. to
your team for case
management or life
care planning of
your clients requiring
spasticity management.
For further information
on the benefits of
medical case management,
vocational counseling,
and life care planning,
contact Betty Reid,
RN at the following: rehabadvisors@bellsouth.net
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