www.wemove.org spasticity slide library version 2.3 - all contents copyright © we move 2001...
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Spasticity Slide Library Version 2.3 - All Contents Copyright © WE MOVE 2001
Spasticity ManagementThe Role of Physical
andOccupational Therapy
Part 3 of 6
Prior to Intervention
• Assess baseline status
• Select appropriate patients
• Determine goals of treatment
• Educate patient and family
• Coordinate with team members
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After the Intervention
• Provide active PT/OT treatment and ongoing evaluation
• Follow-up on home program
• Continue to educate patient and family
• Assess treatment outcomes
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Framework for Assessment
• NCMRR framework – Developed by National Advisory Board of the
National Center for Medical Rehabilitation Research at NIH
– Adopted by the American Physical Therapy Association
– Addresses five dimensions of the disabling process
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Five Dimensions of the Disabling Process
• Pathophysiology: molecular or cellular • Impairment: organ/system
• Functional limitations: whole body or segmental
• Disability: dysfunction in daily roles
• Societal limitations: potential is limited due to societal barriers
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Spasticity Slide Library Version 2.3 - All Contents Copyright © WE MOVE 2001
PT/OT Assessmentand
Goal Setting
Impairment Dimension
• Range of motion (ROM)
–passive and active
–contractures and/or dynamic limitations
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Impairments, cont’d
• Muscle tone - patient may use spasticity for support in functional activities
• Synergies, selective control
• Strength - reduction in spasticity can unmask weakness
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Impairments, cont’d
• Balance
• Endurance, energy costs
• Positioning– bed– sitting (chair,wheelchair,car)– classroom– home
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Impairments, cont’d
• Presence of abnormal developmental reflexes
• Delayed or incomplete integration of normal reflexes
• Absence of age-appropriate equilibrium and righting reactions
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Functional Limitations Dimension
• Head control
• Hand to mouth, grasp/release
• Self-care: age appropriate skills in grooming, bathing, dressing, feeding
• Bed mobility
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Functional Limitations, cont’d
• Sitting
• Transfers: home, school, work, community
• Ambulation
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Disability Dimension
• Mobility: work, school, community
• Communication
• Sports, recreation and play
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Spasticity Slide Library Version 2.3 - All Contents Copyright © WE MOVE 2001
Physical and Occupational Therapy: Treatment Options
Therapeutic Exercise
• Stretching and range of motion
• Myofascial and joint mobilization
• Active assistive, active and resistive exercise
• Facilitate useful co-contraction
• Endurance training
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Functional Training
• Self care activities• Bed mobility• Coming to sit; balance and
mobility• Transfer training
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Functional Training, cont’d
• Wheelchair mobility
• Gait training
• Advanced ambulation skills
• Skills for recreation, sports
• Communication skills
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Modalities
Must be individualized and not always indicated:
• Heat, cold, biofeedback
• Electrical stimulation (NMES, FES, TES)– Efficacy not well documented– Utilized to:
• Stimulate a weak agonist
• Reduce spasticity in antagonist
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Bracing
• AFOs most common lower extremity brace
• With spasticity, may need to change bracing
• Consider skin tolerance and wearing time
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Positioning Splints
• Upper and lower extremity
• Passive or dynamic
• Dynamic brace + ES
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Serial Casting
• Adjunct to pharmacological intervention, chemodenervation
• Can aid in gaining ROM
• Short-leg casts with dorsiflexion cut-out
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Equipment
The therapist’s role includes:
• Evaluation of need
• Preparation of funding justification
• Instruction of patient and family in use and maintenance
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Seating Systems
• Enhance mobility, cognitive, and communication skills
• Provide interaction with environment
• Maximize upper extremity and respiratory function
• Minimize deformity and skin problems
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ADL and Mobility Equipment
Examples of ADL and mobility equipment include:
• Modified eating utensils
• Bathtub lifts and bathing aids
• Orthoses and walkers
• Wheelchairs
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Safety Issues
• Abrupt changes in tone require attention to safety issues
• Re-evaluate equipment, bracing and splinting
• Assess and re-teach transfers
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