Nurses take an active role in the schwab clinic to. 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. Pt classroom the role of the physical therapist for management of spasticity. Physiotherapy is vital for correct positioning, seating, use of orthoses, splints and casts and for other antispastic measures such. Together, they result in impairments and functional problems that can predispose to costly complications.
While spasticity cannot be cured, there are a number of ways to treat it. Physical and pharmacological treatments can reduce pain and discomfort. You will receive an email whenever this article is corrected, updated, or cited in the literature. Spasticity is a spasm or tightening of a muscle or muscles, rendering them stiff, overactive, and difficult to. Managing spasticity in the outpatient rehabilitation continuum. The overactivity in the muscles is due to a disturbance in the messages coming from the brain. The use of hydrotherapy for the management of spasticity n. Xrays or other types of imaging may be used to rule out broken bones or problems with circulation. Transcutaneous electrical nerve stimulation tens units have been shown to be useful in the management of pain. The indicated treatment for spasticity depends greatly on the specific features of the individual patient case. Your physician will test how well you can move your arms and legs and whether certain movements make your muscles tighten up. Oral medication and other modalities such as heat, cold, ultrasound, electrical.
Current practice in the uk regarding bonta for spasticity management. Spasticity is isokinetic abnormal but not increased movements, while dystonia and other movement disorders are hyperkinetic abnormal and increased. Nurses take an active role in the schwab clinic to help patients with spasticity by helping with treatments and. The upper motor neuron syndrome is caused by a lesion proximal to the anterior horn cell. Spasticity prevents or limits the development of motor function. Spasticity in adults british society of rehabilitation medicine. Through the basic principles of rehabilitation assessment, goal setting, intervention and evaluation function can be optimized whilst preventing complications and minimizing.
This syndrome is often a chronic, disabling, and painful condition that can result from any injury or illness to the. Chapter 30 spasticity management in longterm care facilities amanda currie and david charles spasticity is an element of the upper motor neuron syndrome defined by a velocitydependent increase in stretch reflex with muscle overactivity 1. It can be triggered at any time through a variety of stimuli. Spasticity can present variably in a clinical setting, spasticity can lead to many complications eg interference with daily function, hygiene, comfort, and nursing care as well as contractures increasing. Is not a measure of spasticity, but scores may by influenced by spasticity 2 is performed at one speed only onesecond1, so does not capture the velocitydependent component of spasticity good screening tool to indicate when further assessment needed 1. Spasticity and functions more than 80% of children with cerebral palsy in hong kong belong to the spastic type2. Oct 01, 2004 spasticity is a pervasive and debilitating condition that frequently occurs following upper motor neuron umn lesions. Tone is the resistance of muscles to passive stretch or elongation, basically the amount of tension a muscle has at rest. Proper management of spasticity can go a long way toward giving patients with ms relief and.
Spasticity is a velocitydependent increase in muscle tone in response to passive movement. Mccrea 2008 recently suggested that spasticity may be interpreted as an umbrella term for all the positive, active symptoms of the upper motor neuron syndrome that. Role of physical therapist for management of spasticity cyberpt. Pdf rehabilitation procedures in the management of spasticity. Spasticity occurs when this coordination is impaired and too many muscles contract at the same time. Pandyan 2005 proposed that spasticity could be defined as disordered sensory. Physiotherapy treatment approaches for individuals with. Hydrotherapy for the management of spasticityet al. How intrathecal baclofen therapy may help to manage your spasticity. They also observed that spasticity primarily affects the elbow 79% of patients, the.
Pyramidal tract injury doesnt give rise to spasticity. Jan 20, 2017 spasticity is caused by an imbalance of signals from the central nervous system brain and spinal cord to the muscles. Spasticity refers to muscle tightness, stiffness, and cramping that cant be controlled. The main goals of spasticity management are to relieve symptoms, increasefunction, patient independence and decrease caregiver burden. Introduction spasticity is defined as disordered sensorimotor control resulting from an upper motor neurone umn lesion, presenting as intermittent or sustained involuntary activation of muscles. Spasticitymuscle tightness and tone management unusual tightness in your childs muscles, sometimes caused by spasticity, can interfere with his or her ability to eat, talk and move. Canadian spasticity group resident training program in the. Spasticity effect of comprehensive care and spasticity management on adl selfperformance and care delivery 205 pts intellectual disability id, 72 spasticity interfered w care or function and at least 1 adl care goal 54 met criteria, 38 consented, 20 completed 14 cp baseline evaluation mas, rom, timed and videotaped care task. Drug treatment can be used for general ised spasticity or.
Botulinum toxin combined with physiotherapy andor orthopaedic surgery is. Risk factors for cp low birth weight spasticity increases care needs and utilisation of healthcare resources,3 and carers of patients with spasticity are more likely to experience anxiety and depression. Satkunam abstract spasticity refers to an abnormal, velocitydependent i. The resident training program in the management of spasticity is a national educational initiative designed to enhance residents experience with the treatment and management of spasticity. Muscle spasms are uncontrolled jerking movements which can occur at night or can be. Spasticity is spasticity is a significant concern among those who have suffered severe brain injuries tbi or spinal cord injuries sci. Pdf spasticity is a disabling problem for many adults and children with a variety of neurological disorders such as multiple sclerosis, stroke.
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. It is part of the upper motor neurone syndrome manifesting as increased tone, clonus, spasms, spastic. From there he recieved his medical degree from memorial university in canada. Managing severe spasticity rady childrens hospital. Spasticity affects muscles, but is caused by damage to the nerves that control muscles. Spasticity is a pervasive and debilitating condition that frequently occurs following upper motor neuron umn lesions. Pharmacologic management of spasticity following stroke. Since publication of the first edition, spasticity. Management of spasticity for children with cp aims at improving the biomechanical alignment of the body and in turn improves functions. Spasticitymuscle tightness and tone management program. Spasticity is a motor disorder marked by a velocitydependent increase in muscle tone or tonic stretch reflexes associated with hypertonia.
However, the onset of spasticity is highly variable and can occur in the short, medium or longterm poststroke period 7. Spasticity is common in many neurological disorders, such as stroke and multiple sclerosis. Physiotherapy in spasticity management for children with. Canadian spasticity group resident training program in the management of spasticity. In the last 3 decades, selective posterior rhizotomy spr has been used in the management of these patients for reduction of spasticity which may result in an improvement of their active functional mobility. Upper motor neurons, the long nerves that start in the brain and extend. It manifests as irregular and involuntary behavior within the muscles. Msrelated spasticity can occur with active movement or be present at rest.
Brashear and a diverse team of specialists have come together to integrate new research. Spasticity, however, is a particular type of hypertonia in which the muscles spasms are increased by movement. Spasticity is caused by an imbalance of signals from the central nervous system brain and spinal cord to the muscles. Spasticity is defined as a velocitydependent, increased resistance to passive muscle stretch.
Whether the impact of spasticity on an individual is mild or severe, it is important that patients are knowledgeable about spasticity, its associated features, and how they can. Functional task carecomfort fixed contracture selective motor control dexterity strength muscle stiffness spasticity. Management of spasticity should be multimodal and should always include. External factors such as constipation, urinary tract infections, and pressure ulcers may exacerbate spasticity and its symptoms. When assessing spasticity it is important to remember that there are other factors to consider which can impact spasticity and therefore the reliability measurement. Poststroke spasticity pss is a common complication associated with other signs and symptoms of the upper motor neuron syndrome, including agonistantagonist cocontraction, weakness, and lack of coordination. The word spasticity refers to involuntary muscle stiffness or spasms sudden muscle contractions. Spasticity is a term that is often used interchangeably with hypertonia. Physical treatment interventions for managing spasticity. Spasticity is a common symptom that arises in a wide range of neurological conditions. Dec 17, 20 the etiology of spasticity in multiple sclerosis is either a result of the stiffness of muscle tone over a sustained period of time, or the result of intermittent spasms. Some patients with spasticity do not require any form of major treatment and simple. The most widely used procedures for management of spasticity are represented by.
Evidencebased management strategies for spasticity treatment in multiple sclerosis clinical practice guidelines. 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. Management of spasticity in stroke during sitting and lying to discourage the development of abnormal posture therapeutic positioning of the patient aims to manipulate primitive reflexes, e. Through its nociceptive action and resultant reduction in pain it was felt that it could reduce spasticity. Doctors, physiotherapists, occupational therapists, and nurses across primary and secondary care can play key roles in working with the individual and their carers to assess the degree and impact of spasticity, identify goals of treatment, initiate referrals for specialist advice, implement management programmes, and monitor the effects of such. As highlighted by gunel 2011 pediatric rehabilitation requires a multidisciplianary mdt approach in order to promote the independence of the child with an impairment, both functionally and psychologically and increase the quality of life of both the child and their family. Spasticity effect of comprehensive care and spasticity management on adl selfperformance and care delivery 205 pts intellectual disability id, 72 spasticity interfered w care or function and at least 1 adl care goal 54 met criteria, 38 consented, 20 completed 14 cp baseline evaluation mas, rom, timed and videotaped care task spasticity treatment initiated, fu after optimization. Spasticity management can be particularly challenging, but rewarding if physical and pharmacological measures are used appropriately and in a timely manner. Spasticity assessment form affix identification label here urn. Spasticity is a major problem for the rehabilitation team. The impact of spasticity varies from it being a subtle neurological sign to severe spasticity causing pain and contractures. Physiotherapists, viewed as the movement expert, play a key role within this mdt.
It is part of the upper motor neurone syndrome manifesting as increased tone, clonus, spasms, spastic dystonia and cocontractions. Spasticity is a component of the upper motor neuron syndrome umns. Spasticity is defined as velocity dependent resistance to movement. Find out more about spasticity and spasms, and new treatment strategies in this az entry. Identification and management of any trigger or aggravating factors initial assessment should exclude. Spasticity and its management information for patients this leaflet provides information to patients on how to manage spasticity. Rehabilitation strategies you will receive an email whenever this article is corrected, updated, or cited in the literature. Chartered society of physiotherapy, association of chartered physiotherapists in neurology and the. Symptomatic treatment of spasticity in multiple sclerosis. This nerve damage can result from stroke, multiple sclerosis ms, spinal cord injury, or other types of brain damage. Current clinical management of spasticity involves a wide variety of therapies ranging from noninvasive eg, oral administration of antispastic drugs, physiotherapy to invasive procedures eg, surgical rhizotomy. Pdf the use of hydrotherapy for the management of spasticity. Understanding the underlying pathology and possible prognosis is helpful in planning these goals.
Spasticity is a symptom of multiple sclerosis where the muscles feel stiff, heavy and difficult to move. Spasticity is derived from the greek word spasticus, which means to pull. Spasticity and its management the hillingdon hospitals. This imbalance is often found in people with cerebral palsy, traumatic brain injury, stroke, multiple sclerosis, and spinal cord injury.
Oct 26, 2015 the first step in the management of spasticity is to identify the key aims and realistic goals of therapy. Rather, the main symptoms are weakness and loss of dexterity which is greater in distal than in the proximal muscles. It is important to stress to patients that spasticity is a highly manageable symptom and does not necessarily need to lead to disability. Brain or nerve damage due to injury or disease can disrupt these signals and cause an abnormal muscle contraction in the form of muscle spasms andor spasticity. Spasticity is abnormal muscle stiffness or overactivity in a group or groups of muscles. Pdf spasticity is a major disabling symptom in many patients with spinal andor cerebral lesions. Using a multidisciplinary approach, spasticity management. Electrical stimulation is another modality that can help spasticity management.
Spasticity is one of the components of the umn syndrome but should not be considered in isolation when it comes to management strategies. Neurological rehabilitation and the management of spasticity. Spastic muscles may also cause jerky movements, or spasms. Risk factors for cp low birth weight of children with cp had a birth weight spasticity increases care needs and utilisation of healthcare resources,3 and carers of patients with spasticity are more likely to experience anxiety and depression. Practical approaches to spasticity management iomsn. The pyramidal tract is the system which balances muscle tone. You can manage this and all other alerts in my account.
Pdf physiotherapy management of spasticity researchgate. In any coordinated movement, some muscles relax while others contract. The type and rate of treatment depend on the levels of spread diffuse versus focal and disability mild vs severe caused by. Role of physical therapist for management of spasticity. Unfortunately, a poor understanding and inadequate management of spasticity often results in it having a greater impact on patients than necessary. Clinical management of spasticity journal of neurology. Jun 28, 2019 spasticity is increased, involuntary, velocitydependent muscle tone that causes resistance to movement. The first step in the management of spasticity is to identify the key aims and realistic goals of therapy.
948 246 31 211 645 729 1257 333 1051 1237 690 1092 797 460 562 192 1487 722 999 469 901 1348 1185 131 980 447 986 881