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Spasticity Management The Role of Physical and Occupational Therapy

Spasticity Management The Role of Physical and Occupational Therapy. Part 3 of 6. Prior to Intervention. Assess baseline status Select appropriate patients Determine goals of treatment Educate patient and family Coordinate with team members. www.wemove.org. After the Intervention.

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Spasticity Management The Role of Physical and Occupational Therapy

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  1. Spasticity ManagementThe Role of PhysicalandOccupational Therapy Part 3 of 6

  2. Prior to Intervention • Assess baseline status • Select appropriate patients • Determine goals of treatment • Educate patient and family • Coordinate with team members www.wemove.org

  3. After the Intervention • Provide active PT/OT treatment and ongoing evaluation • Follow-up on home program • Continue to educate patient and family • Assess treatment outcomes www.wemove.org

  4. Framework for Assessment • NCMRR framework • Developed by National Advisory Board of the National Center for Medical Rehabilitation Research at NIH • Adopted by the American Physical Therapy Association • Addresses five dimensions of the disabling process www.wemove.org

  5. Five Dimensions of the Disabling Process • Pathophysiology: molecular or cellular • Impairment: organ/system • Functional limitations: whole body or segmental • Disability: dysfunction in daily roles • Societal limitations: potential is limited due to societal barriers www.wemove.org

  6. PT/OT AssessmentandGoal Setting

  7. Impairment Dimension • Range of motion (ROM) • passive and active • contractures and/or dynamic limitations www.wemove.org

  8. Impairments, cont’d • Muscle tone - patient may use spasticity for support in functional activities • Synergies, selective control • Strength - reduction in spasticity can unmask weakness www.wemove.org

  9. Impairments, cont’d • Balance • Endurance, energy costs • Positioning • bed • sitting (chair,wheelchair,car) • classroom • home www.wemove.org

  10. Impairments, cont’d • Presence of abnormal developmental reflexes • Delayed or incomplete integration of normal reflexes • Absence of age-appropriate equilibrium and righting reactions www.wemove.org

  11. Functional Limitations Dimension • Head control • Hand to mouth, grasp/release • Self-care: age appropriate skills in grooming, bathing, dressing, feeding • Bed mobility www.wemove.org

  12. Functional Limitations, cont’d • Sitting • Transfers: home, school, work, community • Ambulation www.wemove.org

  13. Disability Dimension • Mobility: work, school, community • Communication • Sports, recreation and play www.wemove.org

  14. Physical and Occupational Therapy: Treatment Options

  15. Therapeutic Exercise • Stretching and range of motion • Myofascial and joint mobilization • Active assistive, active and resistive exercise • Facilitate useful co-contraction • Endurance training www.wemove.org

  16. Functional Training • Self care activities • Bed mobility • Coming to sit; balance and mobility • Transfer training www.wemove.org

  17. Functional Training, cont’d • Wheelchair mobility • Gait training • Advanced ambulation skills • Skills for recreation, sports • Communication skills www.wemove.org

  18. Modalities Must be individualized and not always indicated: • Heat, cold, biofeedback • Electrical stimulation (NMES, FES, TES) • Efficacy not well documented • Utilized to: • Stimulate a weak agonist • Reduce spasticity in antagonist www.wemove.org

  19. Bracing • AFOs most common lower extremity brace • With spasticity, may need to change bracing • Consider skin tolerance and wearing time www.wemove.org

  20. Positioning Splints • Upper and lower extremity • Passive or dynamic • Dynamic brace + ES www.wemove.org

  21. Serial Casting • Adjunct to pharmacological intervention, chemodenervation • Can aid in gaining ROM • Short-leg casts with dorsiflexion cut-out www.wemove.org

  22. Equipment The therapist’s role includes: • Evaluation of need • Preparation of funding justification • Instruction of patient and family in use and maintenance www.wemove.org

  23. Seating Systems • Enhance mobility, cognitive, and communication skills • Provide interaction with environment • Maximize upper extremity and respiratory function • Minimize deformity and skin problems www.wemove.org

  24. ADL and Mobility Equipment Examples of ADL and mobility equipment include: • Modified eating utensils • Bathtub lifts and bathing aids • Orthoses and walkers • Wheelchairs www.wemove.org

  25. Safety Issues • Abrupt changes in tone require attention to safety issues • Re-evaluate equipment, bracing and splinting • Assess and re-teach transfers www.wemove.org

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