The management of spasticity in multiple sclerosis david a. Its gradual development is caused by a group of neurophysiologic mechanisms emerging after central nervous system cns injury. The upper motor neuron syndrome is caused by a lesion proximal to the anterior horn cell. Stimulation of the flexor reflex afferents may lead to an increase in pathologic activity. Interrater reliability of a modified ashworth scale of muscle spasticity physical therapy 1987, 67. From there he recieved his medical degree from memorial university in canada. Limited motion, especially in joints that can limit walking or moving in and out of beds or. Different physical modalities use for spasticity management are followings. Management of spasticity for children with cp aims at improving the biomechanical alignment of the body and in turn improves functions. Muscle alterations due to spasticity motor control of the wrist and hand is normally balanced by the continual eccentric and concentric contractions of both the extensor and the flexor muscles ponten 2008balance in children with spasticity there is deficient motor control. Pdf physiotherapy management of spasticity researchgate.
Spasticity management a practical multidisciplinary. Feb, 2017 this is a common therapeutic modality in physiotherapy used to treat developed spasticity by altering the excitability of the alpha motoneurons. Oral medication and other modalities such as heat, cold, ultrasound, electrical stimulation, and surgery. Effectiveness of physiotherapy interventions on spasticity. Multiple sclerosis council for clinical practice guidelines. The use of hydrotherapy for the management of spasticity. Hemiparesis is unilateral paresis, that is, weakness of the entire left or right side of the body. Predict the occurrence of spasticity and could provide insight into its neurological basis. It may cause disability in numerous neurological conditions such as cerebral paresis, multiple sclerosis, brain injury and spinal cord injury. Physiotherapy treatment approaches for individuals with.
Medicine, chartered society of physiotherapy association of chartered physiotherapists interested in neurology, spasticity in adults. 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. Tardieu scale velocity to stretch v quality of muscle. The main focal treatment options are physical therapy including physiotherapy and botulinum toxin type a bonta. Botulinum toxin injection techniques for the management of.
Spasticity is a common symptom that arises in a wide range of neurological conditions. Splinting an adjunct in the management of hypertonicity. A thorough 2017 version of the document appears at spasticity management with a focus on rehabilitation. Spasticity is a motor disorder marked by a velocitydependent increase in muscle tone or tonic stretch reflexes associated with hypertonia. 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. Pdf spasticity is common in many neurological disorders, such as stroke and multiple sclerosis. Mccrea 2008 recently suggested that spasticity may be interpreted as an umbrella term for all the positive, active symptoms of the upper. Spasticity can be reduced with proper care and treatment such as physiotherapy, occupational therapy.
It also affects the elders mobility and activities of daily living. The use of hydrotherapy for the management of spasticity n. Together, they result in impairments and functional problems that can predispose to costly complications. Red plans in place to develop referral process or documented pathway for spasticity management, including staff training and patientcarer information amber spasticity management pathway in place in some parts of the mcn area but approach is inconsistent. This is a pdf file of an unedited manuscript that has been accepted for publication. Physical therapy treatment of spasticity pdf key words.
Measure of resistance to passive movement 1 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. Effectiveness of physiotherapy interventions on spasticity in people with multiple sclerosis. Physical therapy in spasticity richardson 2002 european. Physiotherapists are part of the rehabilitation team involved in the management of adult spasticity. Drug treatment can be used for general ised spasticity or. Effectiveness of physiotherapy interventions on spasticity in. Pdf assessment and treatment of spasticity in children. Physiotherapists, viewed as the movement expert, play a key role within this mdt. An overview of the clinical management of spasticity 5 toenails or small pressure sores can, in turn, exacer bate the spasticity, and a vicious cir cle of increased. This is our first video release from our 2015 stanford 25 skills symposium. Spasticity and functions more than 80% of children with cerebral palsy in hong kong belong to the spastic type2.
The aim of this national guideline is to assist individual clinicians, primary care teams and hospital departments to optimise their management of stroke patients. Through the basic principles of rehabilitation assessment, goal setting, intervention and evaluation function can be optimized whilst preventing complications and minimizing. Pt classroom the role of the physical therapist for management of spasticity. Jan 19, 2017 hemiplegia means complete paralysis of half of the body. Physical therapy is one part of the armoury in the fight against this disabling symptom of the upper motor neurone syndrome. Pdf spasticity is a disabling problem for many adults and children with a variety of neurological disorders such as multiple sclerosis, stroke. Recent publications provide evidence based guidelines for overall management of mnd phukan and hardiman, 2009. Spasticity is a component of the upper motor neuron syndrome umns. It is defined as a group of nonprogressive but often changing motor impairment syndromes secondary to lesions or anomalies of brain arising in early stages of its development.
Physiotherapy in spasticity management for children with. Apr, 2017 different physical modalities use for spasticity management are followings. Ultrasound ultrasound therapy is assumed to have a viscoelastic changes in spastic muscle but also decreases the sensitivity of the muscle spindle to stretch and alpha motorneuron excitability by increasing the tissue temperature. Pdf rehabilitation procedures in the management of spasticity. Spasticity and muscle overactivity have been shown to be increased as a result of this input. Pandyan 2005 proposed that spasticity could be defined as disordered sensory. The management of spasticity after stroke description. When assessing spasticity it is important to remember that there are other factors to consider which can impact spasticity and therefore the reliability measurement. Clinical management of spasticity journal of neurology. Hemiplegia means complete paralysis of half of the body. A comparison of uk physiotherapy and rehabilitation medicine injectors abstract backgroundaims. Steve mcgee talks about the approach to differentiating spasticity versus rigidity at the bedside. Physical therapy and its benefits for those with living with ms duration.
Spasticity versus rigidity stanford 25 skills symposium. Spasticity is defined as velocity dependent resistance to movement. Current interventions to treat spasticity lack a robust evidence base, and guidelines often depend on expert recommendations. Mar 25, 2002 physiotherapists are part of the rehabilitation team involved in the management of adult spasticity. Identifying the physiological changes brought about by physical therapy or physiotherapy, is difficult. Spasticity as a motor disorder is a result of injury to the brain andor the spinal cord. Keywords physiotherapy, stroke, spasticity, treatment, upper motoneuron syndrome history received 29 october 2012 revised 20 april 20 accepted 7 may 20. Effectiveness of physiotherapy interventions on spasticity i. 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. Can you differentiate between spasticity versus rigidity. Evidencebased management strategies for spasticity treatment in multiple sclerosis clinical practice guidelines. Sometimes, however, there are problems caused by spasticity that can be bothersome or harmful. Physiotherapy for spasticity control reduction of noxious stimulation the first step in any program to manage spasticity is the reduction of noxious stimulation.
Spasticity is a major problem for the rehabilitation team. Spasticity prevents or limits the development of motor function. Summarize benefits of physical therapy for patients with ms. Spasticity is derived from the greek word spasticus, which means to pull. It is important to stress to patients that spasticity is a highly manageable symptom and does not necessarily need to lead to disability. Spasticity management can be particularly challenging, but rewarding if physical and pharmacological measures are used appropriately and in a timely manner. Hemiplegia is caused by damage to central nervous system brain. Aquatic therapy provides countless opportunities to experience, learn, and enjoy new movement skills, which leads to increase functional skills, mobility and builds selfconfidence. For each muscle group, reaction to stretch is rated at a specified stretch velocity with 2 parameters x and y. There are many subtle considerations in the management of spasticity, and. Spasticity lance, 1980 motor disorder velocity dependent increase in tonic stretch reflexes hyperexcitability of the stretch reflex exaggerated tendon jerks one component of the upper motor neuron syndrome altered activity patterns of motor units occurring in response to sensory and central command signals which lead to cocontractions, mass movements, and. Tardieu scale for brain injury patients physiotherapy author. Spasticity can be reduced with proper care and treatment such as physiotherapy, occupational therapy, medication and surgery.
Spasticity management involves diverse approaches including physiotherapy pt interventions, transcranial magnetic stimulation, and antispastic medications as baclofen by oral or intrathecal administration, and botulinum toxin a. Physical treatment interventions for managing spasticity. This is the first edition of the irish guidelines for the physiotherapy management of motor neuron disease mnd. Ation and treatment of spasticity for many decades. Grading is always performed at the same time of day, in a constant position of the body for a given limb. Ppt the management of spasticity after stroke powerpoint. Physiotherapy is vital for correct positioning, seating, use of orthoses, splints and casts and for other antispastic measures such. Clinical guidelines for stroke management 2010 the following organisations have provided valuable input into the development of this document and the national stroke foundation gratefully acknowledges their endorsement of the clinical guidelines for stroke management 2010.
Practical approaches to spasticity management iomsn. Physical treatment interventions for managing spasticity after stroke. Management of spasticity should be multimodal and should always include. This material is ed and further reproduction or distribution is prohibited. Kostandinos tsoulfas completed his undergraduate training at wisconsin lutheran college. To compare patient outcomes following botulinum toxin bont injection by either physiotherapy or rehabilitation medicine medical professionals over a 3year period.
This video is a part of a larger group of videos that were created during the symposium. Spasticity is not always harmful or bothersome and does not always need to be treated. 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. Jul 05, 2018 presented by jackie harris, ms physiotherapist.
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. Australian and new zealand society for geriatric medicine. Spasticity is characterized by muscle stiffness, pain, loss of range of joint movement and muscle strength. This is a common therapeutic modality in physiotherapy used to treat developed spasticity by altering the excitability of the alpha motoneurons. Discuss treatment goals for patients with spasticity, including prevention of complications. Role of physical therapist for management of spasticity cyberpt. Keywords physiotherapy, stroke, spasticity, treatment, upper motoneuron syndrome history received 29 october 2012 revised 20 april 20 accepted 7 may 20 published online 25 july 20 introduction spasticity was first described by lance 1 in 1980 as a. 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. Unfortunately, a poor understanding and inadequate management of spasticity often results in it having a greater impact on patients than necessary. Hemiplegia and hemipareis can be caused by different medical conditions, such as congenital causes, trauma, tumors or stroke. Muscle spasticity pdf to html without losing formatting muscle stretching exercises. The focus is on general management, rehabilitation, the prevention and management of complications and discharge planning, with an emphasis on the first 12 months after stroke. 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. Hemiplegia and physiotherapy rehabilitation exercise detail.
The relief of hypertonus in the spastic type of cp is one of the major advantages of aquatic therapy. It is essential that management targets function and is always patient focused rather than aimed at reducing the degree of spasticity. Managing severe spasticity rady childrens hospital. Pdf spasticity is a major disabling symptom in many patients with spinal andor cerebral lesions. Role of physical therapist for management of spasticity.
Spasticity is one of the components of the umn syndrome but should not be considered in isolation when it comes to management strategies. Management of spasticity requires a balanced approach, weighing the benefits of treatment against the usefulness of the spasticity. Neurological rehabilitation and the management of spasticity. The main treatment aims for upper limb focal arm spasticity are to improve passive function to make it easier to care for the limb or to restore active function when possible or management of symptoms such as pain. Spasticity and contracture i physiotherapy management.
Neuroimaging may help predict the occurrence of spasticity and could provide insight into its neurological basis. Oral medication and other modalities such as heat, cold, ultrasound, electrical stimulation, and surgery neurosurgical or orthopedic can also be used. Botulinum toxin combined with physiotherapy andor orthopaedic surgery is. The most widely used procedures for management of spasticity are represented by. Functional task carecomfort fixed contracture selective motor control dexterity strength muscle stiffness spasticity.1657 42 1464 409 1102 1295 1242 1500 793 1107 1111 793 503 975 677 1130 1439 1063 1223 507 509 1543 1038 225 704 1509 678 743 215 1339 1055 1497 187 1164 1302 182 64 122 1027 360 949