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Spasticity: Evaluation and Treatment Planning

Spasticity: Evaluation and Treatment Planning. Part 2 of 6. Modified Ashworth scale 0 to 4 scale of tone intensity Oswestry scale rates stage and distribution of tone “useful” vs. “non-useful” movement. Degree of adductor muscle tone (Snow) Tardieu scale measures tone vs. velocity.

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Spasticity: Evaluation and Treatment Planning

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  1. Spasticity: Evaluation and Treatment Planning Part 2 of 6

  2. Modified Ashworth scale 0 to 4 scale of tone intensity Oswestry scale rates stage and distribution of tone “useful” vs. “non-useful” movement Degree of adductor muscle tone (Snow) Tardieu scale measures tone vs. velocity Evaluation of Tone:Clinical Rating Scales www.wemove.org

  3. Spasm frequency Global motor impairment Global disability Upper extremity strength and dexterity Pain Gait Goniometry Electrophysiologic/biomechanical ADL/hygiene Patient/caregiver QOL Pediatric-specific measures Other Measures www.wemove.org

  4. Common Clinical Patterns: Upper Limbs

  5. Common Clinical Patterns: Lower Limbs

  6. Muscle Identification • Clinical exam • knowledge of functional anatomy is critical • Dynamic electromyography • overactivity, co-contraction • may be silent in severely affected muscle • Motor point block • lidocaine, etidocaine, bupivacaine • Gait lab analysis www.wemove.org

  7. Technical Questions in the Diagnostic Exam • How are overactivity and contracture impairing function? • Are spasticity and contracture preventing full stretch and joint range of motion? • Which muscles are contributing to the pathological posture? • Can performance of other muscles improve if free of opposing co-contraction? www.wemove.org

  8. Considerations in Treatment Decisions • Chronicity • acute vs. chronic • Severity • Distribution • diffuse vs. focal • Locus of CNS injury www.wemove.org

  9. Considerations in Treatment Decisions, cont’d • Co-morbidities • Degree of underlying selective control • Cognitive or psychiatric impairment • Contracture • Availability of care and support • baclofen pump expertise • reimbursement issues • Potential for complications www.wemove.org

  10. Rationale for Treatment • If spasticity interferes with: • functioning • positioning • comfort • care • If spasticity is not useful, e.g., during transfers • If treatment is expected to provide meaningful improvement www.wemove.org

  11. Setting Goals of Treatment No meaningful plan can be formulated without first determining the goals of treatment including: • patient/caregiver goals • functional goals • technical goals www.wemove.org

  12. Increased ROM Decrease energy expenditure Decreased spasm frequency Decreased pain Improved mobility Improved gait Improved orthotic fit Improved positioning Increased ease of hygiene Improved cosmesis Possible Treatment Goals www.wemove.org

  13. The Spasticity Management Team • Neurologist • Physiatrist • Neurosurgeon; orthopedic surgeon • PT and OT • Family and other caregivers • Coordinator/administrator • Wheelchair clinic, gait lab, orthotics clinic, counseling, social work www.wemove.org

  14. Rehabilitation Oral medication Intrathecal baclofen Chemodenervation Neurosurgery Orthopedic surgery Spasticity: Treatment Options Medical stabilization and removal of noxious stimuli (heterotopic ossification, ingrown toenail, etc.) precede other treatments www.wemove.org

  15. An Algorithm for the Management of Spasticity

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