Physiotherapy management of spasticity pdf

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. Physical therapy treatment of spasticity pdf key words. 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. Pdf assessment and treatment of spasticity in children.

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. Pdf spasticity is common in many neurological disorders, such as stroke and multiple sclerosis. 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. The aim of this national guideline is to assist individual clinicians, primary care teams and hospital departments to optimise their management of stroke patients. There are many subtle considerations in the management of spasticity, and. A thorough 2017 version of the document appears at spasticity management with a focus on rehabilitation. 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. A comparison of uk physiotherapy and rehabilitation medicine injectors abstract backgroundaims. Spasticity management can be particularly challenging, but rewarding if physical and pharmacological measures are used appropriately and in a timely manner. Effectiveness of physiotherapy interventions on spasticity in people with multiple sclerosis.

The most widely used procedures for management of spasticity are represented by. Australian and new zealand society for geriatric medicine. Summarize benefits of physical therapy for patients with ms. Neurological rehabilitation and the management of spasticity. Physiotherapy for spasticity control reduction of noxious stimulation the first step in any program to manage spasticity is the reduction of noxious stimulation. Spasticity and contracture i physiotherapy management. Limited motion, especially in joints that can limit walking or moving in and out of beds or. Managing severe spasticity rady childrens hospital.

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 is not always harmful or bothersome and does not always need to be treated. 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. Mccrea 2008 recently suggested that spasticity may be interpreted as an umbrella term for all the positive, active symptoms of the upper. Can you differentiate between spasticity versus rigidity.

This video is a part of a larger group of videos that were created during the symposium. Physical treatment interventions for managing spasticity after stroke. Current interventions to treat spasticity lack a robust evidence base, and guidelines often depend on expert recommendations. 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. Physical therapy and its benefits for those with living with ms duration. Aquatic therapy provides countless opportunities to experience, learn, and enjoy new movement skills, which leads to increase functional skills, mobility and builds selfconfidence. Spasticity management a practical multidisciplinary. Spasticity and functions more than 80% of children with cerebral palsy in hong kong belong to the spastic type2. Predict the occurrence of spasticity and could provide insight into its neurological basis. Drug treatment can be used for general ised spasticity or. Through the basic principles of rehabilitation assessment, goal setting, intervention and evaluation function can be optimized whilst preventing complications and minimizing. Spasticity is derived from the greek word spasticus, which means to pull. It may cause disability in numerous neurological conditions such as cerebral paresis, multiple sclerosis, brain injury and spinal cord injury.

The relief of hypertonus in the spastic type of cp is one of the major advantages of aquatic therapy. Effectiveness of physiotherapy interventions on spasticity in. Clinical management of spasticity journal of neurology. Physiotherapy in spasticity management for children with. Spasticity is defined as velocity dependent resistance to movement. Oral medication and other modalities such as heat, cold, ultrasound, electrical stimulation, and surgery. Jul 05, 2018 presented by jackie harris, ms physiotherapist. Tardieu scale for brain injury patients physiotherapy author.

Physiotherapy is vital for correct positioning, seating, use of orthoses, splints and casts and for other antispastic measures such. The use of hydrotherapy for the management of spasticity. 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. 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. Hemiplegia means complete paralysis of half of the body. The upper motor neuron syndrome is caused by a lesion proximal to the anterior horn cell. The management of spasticity in multiple sclerosis david a. Sometimes, however, there are problems caused by spasticity that can be bothersome or harmful. Different physical modalities use for spasticity management are followings. This is a pdf file of an unedited manuscript that has been accepted for publication.

Spasticity is one of the components of the umn syndrome but should not be considered in isolation when it comes to management strategies. From there he recieved his medical degree from memorial university in canada. Oral medication and other modalities such as heat, cold, ultrasound, electrical stimulation, and surgery neurosurgical or orthopedic can also be used. It also affects the elders mobility and activities of daily living.

Practical approaches to spasticity management iomsn. Kostandinos tsoulfas completed his undergraduate training at wisconsin lutheran college. Hemiplegia and physiotherapy rehabilitation exercise detail. Spasticity is a common symptom that arises in a wide range of neurological conditions. Apr, 2017 different physical modalities use for spasticity management are followings. Role of physical therapist for management of spasticity cyberpt. Evidencebased management strategies for spasticity treatment in multiple sclerosis clinical practice guidelines. Pdf physiotherapy management of spasticity researchgate.

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. Spasticity can be reduced with proper care and treatment such as physiotherapy, occupational therapy, medication and surgery. Pt classroom the role of the physical therapist for management of spasticity. Hemiparesis is unilateral paresis, that is, weakness of the entire left or right side of the body. Spasticity and muscle overactivity have been shown to be increased as a result of this input. Management of spasticity requires a balanced approach, weighing the benefits of treatment against the usefulness of the spasticity. This material is ed and further reproduction or distribution is prohibited. Mar 25, 2002 physiotherapists are part of the rehabilitation team involved in the management of adult 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. 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. 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.

Neuroimaging may help predict the occurrence of spasticity and could provide insight into its neurological basis. Discuss treatment goals for patients with spasticity, including prevention of complications. Stimulation of the flexor reflex afferents may lead to an increase in pathologic activity. Recent publications provide evidence based guidelines for overall management of mnd phukan and hardiman, 2009. This is our first video release from our 2015 stanford 25 skills symposium. Effectiveness of physiotherapy interventions on spasticity i. Ation and treatment of spasticity for many decades. Pdf rehabilitation procedures in the management of spasticity. Spasticity can be reduced with proper care and treatment such as physiotherapy, occupational therapy. Its gradual development is caused by a group of neurophysiologic mechanisms emerging after central nervous system cns injury. Physiotherapy treatment approaches for individuals with. 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.

Hemiplegia is caused by damage to central nervous system brain. Pdf spasticity is a disabling problem for many adults and children with a variety of neurological disorders such as multiple sclerosis, stroke. This is the first edition of the irish guidelines for the physiotherapy management of motor neuron disease mnd. Spasticity versus rigidity stanford 25 skills symposium. The use of hydrotherapy for the management of spasticity n. Tardieu scale velocity to stretch v quality of muscle. Unfortunately, a poor understanding and inadequate management of spasticity often results in it having a greater impact on patients than necessary. Spasticity is characterized by muscle stiffness, pain, loss of range of joint movement and muscle strength. Role of physical therapist for management of spasticity. Multiple sclerosis council for clinical practice guidelines.

Muscle spasticity pdf to html without losing formatting muscle stretching exercises. Physical treatment interventions for managing spasticity. Physical therapy in spasticity richardson 2002 european. The management of spasticity after stroke description. Splinting an adjunct in the management of hypertonicity. Together, they result in impairments and functional problems that can predispose to costly complications. This scale quantifies muscle spasticity by assessing the response of the muscle to stretch applied at specified velocities. Management of spasticity should be multimodal and should always include. Spasticity as a motor disorder is a result of injury to the brain andor the spinal cord. Interrater reliability of a modified ashworth scale of muscle spasticity physical therapy 1987, 67.

The level of spasticity was considerably decreased after therapy. Pandyan 2005 proposed that spasticity could be defined as disordered sensory. Effectiveness of physiotherapy interventions on spasticity. Medicine, chartered society of physiotherapy association of chartered physiotherapists interested in neurology, spasticity in adults. Feb, 2017 this is a common therapeutic modality in physiotherapy used to treat developed spasticity by altering the excitability of the alpha motoneurons. When assessing spasticity it is important to remember that there are other factors to consider which can impact spasticity and therefore the reliability measurement. Steve mcgee talks about the approach to differentiating spasticity versus rigidity at the bedside. Physiotherapists are part of the rehabilitation team involved in the management of adult spasticity. Ppt the management of spasticity after stroke powerpoint. Physical therapy is one part of the armoury in the fight against this disabling symptom of the upper motor neurone syndrome. Botulinum toxin injection techniques for the management of. 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. 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.

Spasticity is a major problem for the rehabilitation team. Spasticity prevents or limits the development of motor function. 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. Botulinum toxin combined with physiotherapy andor orthopaedic surgery is. 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. Spasticity is a component of the upper motor neuron syndrome umns. This is a common therapeutic modality in physiotherapy used to treat developed spasticity by altering the excitability of the alpha motoneurons. For each muscle group, reaction to stretch is rated at a specified stretch velocity with 2 parameters x and y. Physiotherapists, viewed as the movement expert, play a key role within this mdt. Grading is always performed at the same time of day, in a constant position of the body for a given limb. It is important to stress to patients that spasticity is a highly manageable symptom and does not necessarily need to lead to disability. Jan 19, 2017 hemiplegia means complete paralysis of half of the body. Functional task carecomfort fixed contracture selective motor control dexterity strength muscle stiffness spasticity. Hemiplegia and hemipareis can be caused by different medical conditions, such as congenital causes, trauma, tumors or stroke.