A combination of rehabilitation techniques is needed to facilitate functional improvements. Muscle movements are normally controlled by a complex system that allows some muscles to contract tighten while others relax. Spasticity management janet dean, rn, kennedy krieger institute presentation from the 2010 rare neuroimmunologic disorders symposium. Improving spasticity management in stroke patients russell bond, do, cox rehabilitation medical director, dept. Using a multidisciplinary approach, spasticity management. Treatment is developed based on the patients needs, preferences and goals. A practical guide for clinicians involved in the management of spasticity, this book covers all aspects of upper motor neurone syndrome from basic neurophysiology and measurement techniques to practical therapy. Optimum management of spasticity is dependent on an understanding of its underlying physiology, an awareness of its natural history, an appreciation of the impact on the patient, and a comprehensive approach to minimising that impact which is both multidisciplinary and consistent over time. Written by leading experts in neurology and rehabilitation, the book covers. Clinical management of spasticity journal of neurology. A simplified paradigm for the pathophysiology of spasticity is presented, which. This contraction causes stiffness or tightness of the muscles and can interfere with normal movement, speech and gait. Spasticity is usually caused by damage to the portion of the brain or.
An overview of the clinical management of spasticity. Diazepam is the most widely used benzodiazepine for spasticity management. Spasticity management in disorders of consciousness. Injection workbook for focal spasticity identifying patients, advanced anatomy, and the botox treatment framework warning. While this symptom and its management is wellknown in patients suffering from stroke, multiple. This guideline covers the management of spasticity and coexisting motor disorders and their early musculoskeletal complications in children and young people from birth up to their 19th birthday with nonprogressive brain disorders. Diagnostic evaluation of adult patients with spasticity 329 geoffrey sheean 22. Management of spasticity in neurorehabilitation chapter 11. Spasticity is derived from the greek word spasticus, which means to pull. The differential effect of monoamines on the dorsal and ventral horns is indicated. The condition may occur secondary to a disorder or trauma, such as a tumor, a stroke, multiple sclerosis ms, cerebral palsy, or a spinal cord, brain, or peripheral nerve injury. A practical guide for clinicians involved in the management of spasticity, this book covers all aspects of upper motor neurone syndrome from basic neurophysiology and measurement techniques to practical therapy and the use of orthoses. Spasticity is a disabling problem for many adults and children with a variety of neurological disorders such as multiple sclerosis, stroke, cerebral palsy and traumatic brain injury. Spasticity is a condition in which certain muscles are continuously contracted.
Overview of genetic causes of spasticity in adults and children chapter 23. Current interventions to treat spasticity lack a robust evidence base, and guidelines often depend on expert recommendations. Spasticity is defined as velocity dependent resistance to movement. Cleveland clinic is a nonprofit academic medical center. Spasticity refers to muscle tightness, stiffness, and cramping that cant be controlled. Upper motor neurone syndrome and spasticity clinical management and neurophysiology. Cerebral palsy is the most common condition associated with spasticity in children and young people. Brain sciences free fulltext spasticity management in.
It is only one of the many different features of the upper motor neurone umn syndrome. The many recent advances in the treatment of spasticity have created a need for. The recommended initial dose is 2 mg 3 times daily with a maximum dose of 60 mg daily 20 mg 3 times daily. Upper motor neurone syndrome and spasticity edited by michael. Chapter 11 management of spasticity in neurorehabilitation. Spasticity is common after stroke and other neurological conditions and causes considerable limitations of. Block diagram illustrating the flow of events following spinal cord injury sci. Spasticity is caused by an imbalance of signals from the central nervous system brain and spinal cord to the muscles. Jun 28, 2019 spasticity is increased, involuntary, velocitydependent muscle tone that causes resistance to movement. In summary, stretching activities have the advantage of being a local treatment, with limited risk that has demonstrated proven effect in the management of spasticity. Oct 01, 2004 spasticity is a pervasive and debilitating condition that frequently occurs following upper motor neuron umn lesions. An overview of the clinical management of spasticity, in upper motor neuron syndrome and spasticity.
It is a complex problem which can cause profound disability, alone or in combination with the other features of an upper motor neuron syndrome and can give rise to significant difficulties in the process of rehabilitation. Damage to nerves in the central nervous system can disrupt the pattern. Treatment is essentially physical, but, when this is inadequate, pharmacological intervention may be required. If you continue browsing the site, you agree to the use of cookies on this website. The book is organized into four sections, each of which covers a broad scope of material. Untreated, limb contracture, pain and other complications occur and early management can be most effective. Nov 27, 2012 an overview of the clinical management of spasticity, in upper motor neuron syndrome and spasticity. According to the american association of neurological surgeons, spasticity affects more than an estimated 12 million people worldwide. It is hypothesized to arise from an anarchic reorganization of the pyramidal and parapyramidal fibers and leads to hypertonia and hyperreflexia of the affected muscular groups.
Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. In a spinal cord injury patient, for example, spasticity can have a serious impact on positioning. Although nonsurgical management with physical and occupational therapies, tonereducing drugs, and botulinum injections are the mainstays of therapy, many patients still require surgical treatment. Spasticity management a practical multidisciplinary. The upper motor neuron syndrome is caused by a lesion proximal to the anterior horn cell. Recent studies show that spasticity occurs in 20%30% of all stroke victims and in less than half of those with pareses. Spasticity management and treatment cleveland clinic. I believe this book is a useful reference for professionals and trainees who take care of patients with spasticity. In the dichotomy of leadership summary, we outline the 12 dichotomies with at 1 short combat and business example each. This book remains the most comprehensive guide to diagnosis and management of spasticity in adults and children, and the revised second edition will continue to serve as an invaluable resource for professionals in any discipline who strive to provide quality care to spasticity patients. Most rehabilitation studies for spasticity management are limited to small, randomized, controlled trials. This nerve damage can result from stroke, multiple sclerosis ms, spinal cord injury, or other types of brain damage. Xrays or other types of imaging may be used to rule out broken bones or problems with circulation.
The site of action and nature of effect of the various drugs and interventions used for the management of spasticity after sci are illustrated. Spasticity affects muscles, but is caused by damage to the nerves that control muscles. Spasticity is a physiological consequence of an injury to the nervous system. Rehabilitation strategies you will receive an email whenever this article is corrected, updated, or cited in the literature. Spasticity can cause significant functional limitations. Spastic muscles may also cause jerky movements, or spasms.
Diagnosis and management is the first book solely dedicated to the diagnosis and treatment of spasticity. Spasticity is disruption in muscle movement patterns so that muscles contract all at once. Apr, 2017 spasticity management in neurological condition. Reducing spasticity alone without addressing the negative components of the upper motor neuron syndrome will limit meaningful recovery.
Apr 10, 2014 management when to treat not all spasticity requires treatment inappropriate treatment of spasticity may lead to loss of function, when spasticity is counterbalancing the effects of paresis may need to be treated when it causes pain difficulty performing adl impaired mobility, whether related to ambulation or transfers poor joint positioning. However, spasticity may cause pain, fatigue and other problems. Unlike all other agents discussed, dantrolene works in a completely novel way. Spasticity is a motor disorder frequently encountered after a lesion involving the central nervous system. Hygiene and bladder management may be affected by significant increases in hip adductor tone. You can manage this and all other alerts in my account. Diagnosis and management has been the defining reference and goto source for physicians, therapists, and other health care providers who care for patients with spasticity. Jun 28, 2011 spasticity management janet dean, rn, kennedy krieger institute presentation from the 2010 rare neuroimmunologic disorders symposium.
As a result, many muscles may contract all at once. Download citation a summary of spasticity management a treatment algorithm the muscle overactivity seen in spasticity results in limb stiffness and muscle. Spasticity management services when you have severe spasticity, stiff and rigid muscles, the disabling effects can interfere with your daily life. Management of spasticity requires a balanced approach, weighing the benefits of treatment against the usefulness of the spasticity. Management of spasticity revisited age and ageing oxford. The initial management should focus on the alleviation of external exacerbating causes before specific treatment is considered. These include reciprocal 1a interneuronal inhibition, presynaptic inhibition, renshawmediated recurrent inhibition, group ii afferent inhibition, and golgi tendon organs. Pharmacologic management of spasticity following stroke. Spasticity is an important contributor to disability in children and adults with neurologic disorders. The role of the multidisciplinary team in the management of spasticity has been well described, and good nursing care, optimal posture, and physical therapy underlie the basic principles of treatment. A strategy has been devised which shows that the first choice pharmacological treatment of focal spasticity is botulinum toxin. If nocturnal spasticity is the presenting problem the patient should be started with a single dose at night. Activity profile this enduring material activity is a reproduction of the printed materials from a course at the aanem annual meeting october 69, 2010. Diagnosis and management, edition 2 ebook written by allison brashear, md.
Spasticity is usually caused by damage to nerve pathways within the brain or spinal cord that control muscle movement. The first is a general overview of spasticity and its effects on movement in patients. Pathophysiology of spasticity is not completely understood. This series of articles for rehabilitation in practice aims to cover a knowledge element of the rehabilitation medicine curriculum. Unfortunately, a poor understanding and inadequate management of spasticity often results in it having a greater impact on patients than necessary. But severe spasticity can interfere with your quality of life. Spasticity has many causes and courses of development, so timing of therapy is important spasticity management with a focus on rehabilitation konstantina petropoulou, md, phd member, international neuromodulation society head of 2nd prm department national rehabilitation center athens, greece april 20. Overview of genetic causes of spasticity in adults and children 339 rebecca schule and stephan zuchner 23. Physical modalities cooling of muscles is beneficial in the management of. Spasticity management for spinal cord injury mayo clinic.
In line with the previous edition, this book emphasises the importance of all team members being involved. Nevertheless they are intended to be of interest to a multidiscip. Since publication of the first edition, spasticity. Surgery in the management of spasticity 299 david a. This pioneering work defines spasticity in the broad context of upper motor neuron syndrome and focuses not on a single component, but on the entire constellation of conditions that make up the umns and often lead to disability. Chronic stretch via casting or splints changes reflexive activity and reduces the stretch reflex. Abstract the objective of this study was to present an overview of the prevalence of spasticity after stroke as well as of test instruments and treatments. Spasticity has some benefits, such as helping tone muscles. Approach to spasticity in general practice british journal. Brashear and a diverse team of specialists have come together to integrate new research. Your physician will test how well you can move your arms and legs and whether certain movements make your muscles tighten up. A novel technique involving electrical stimulation triggered by voluntary. Spasticity is a form of muscle overactivity that occurs when communication between your brain and spinal cord is disrupted by a spinal cord injury, other injury or an illness. This imbalance is often found in people with cerebral palsy, traumatic.
Other chapters cover epidemiology and ancillary findings commonly associated with spasticity. Management of spasticity and cerebral palsy intechopen. Upper motor neurone syndrome and spasticity edited by. Spasticity can cause problems with activity and participation in people with a variety of neurological disorders. Clinical evaluation and management of spasticity david a. Most commonly caused by a brain or spinal cord injury, spasticity can make it difficult to walk, control your movements or talk. Spasticity is a condition in which there is an abnormal increase in muscle tone or stiffness of muscle, which might interfere with movement, speech, or be associated with discomfort or pain. Spasticity was defined by lance as a velocitydependent increase in tonic stretch reflexes muscle tone with exaggerated tendon jerks, resulting.
A practical guide for clinicians involved in the management of spasticity, this book covers all aspects of upper motor neurone syndrome from basic neurophysiology and measurement techniques to. It is written by a group of contributors 48 authors with various expertise. A practical multidisciplinary guide provides the essenti. Download for offline reading, highlight, bookmark or take notes while you read spasticity, second edition. The first section of the book follows a traditional textbook format with several chapters describing the assessment and treatment of spasticity. Optimum management of spasticity is dependent on an understanding of its underlying physiology, an awareness of its natural history, an appreciation of the impact on the patient, and a comprehensive approach to minimising that impact which is. Spasticity pathogenesis, prevention and treatment strategies. Managing spasticity may require a team approach to prevent painful and disabling contractures in the hips, knees, ankles, shoulders and elbows. Spasticity is a form of muscle overactivity which can result in contractures, abnormal postures, and pain and stiffness in the muscles of the body due to damage to the central nervous system. Approach to spasticity in general practice british. These examples with additional stories are illustrated in vivid detail in the book, to help you see the principles at work. Spasticity should be treated when it causes pain, interferes with activities of daily living or sleep, or leads to less ability to function. This guideline covers the management of spasticity and coexisting motor disorders and their early musculoskeletal complications in children and young people from birth up to their 19th birthday with nonprogressive brain disorders cerebral palsy is the most common condition associated with spasticity in children and young people. Overview, evaluation, medical management objectives at the conclusion of this program, the learner will be able to.
This introduction provides an overview of spasticity management. Although the exact incidence of spasticity is unknown, it is likely that it affects more than half a million people in the united states alone, and more than 12 million people worldwide. The evidence base for much of what is done is not strong and this summary examines the activities of proven value and of consensus. A summary of spasticity management a treatment algorithm. Spasticity is a common symptom that arises in a wide range of neurological conditions. Distant spread of toxin effect postmarketing reports indicate that the effects of botox and all botulinum toxin products may spread from. Treatment of spasticity is considered when the increased muscle tightness results in. Allison brashear who is an eminent expert and clinician in this field. For example, if your leg muscles are so weak that its hard to walk, a little spasticity may be helpful. Potential goals for spasticity management are considered as are outcome measures for assessing the efficacy of these technologies. A description of spasticity is followed by a brief overview of the pathophysiology of spasticity. It can affect wheelchair positioning as well as transfers. A practical multidisciplinary guide provides the essential knowledge for the effective management of spasticity as well as the practical tools for developing wideranging services.
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