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Neurologic/Geriatric>>Spasticity Management Program - 1/5/2007

Not everyone who has spasticity requires medical treatment; however, in many individuals, spasticity can interfere with function, mobility, self-care, or the ability of a caregiver to care for an individual. Left untreated, spasticity can often lead to muscle contractures, boney deformities, and mobility problems. Spasticity can also interfere with the fit and usefulness of orthoses or seating and mobility devices. Appropriate management and treatment can help reduce spasticity that interferes with day to day functioning and allow for greater independence and functioning. Spasticity is best managed by an interdisciplinary clinical team.

Goals of Spasticity Management:

  • Improve Mobility
  • Increase quality of gait/reduce risk for falls
  • Increase independence with activities of daily living
  • Improve range of motion/prevent contractures
  • Postpone or avoid need for surgical intervention
  • Improve fit of orthotic devices
  • Improve seating & positioning
  • Minimize/avoid deformities

Conditions Treated

  • Cerebral Palsy
  • Stroke
  • Traumatic Brain Injury
  • Multiple Sclerosis
  • Other Upper Motor Neuron Disorders

Spasticity Management Team:

  • Neurologist/Physiatrist
    • Refers the patient for evaluation.
    • Goal setting
    • Treatment decisions
    • Post-surgery monitoring
    • Coordination of spasticity management with other aspects of care
  • Neurosurgeon/Orthopedic Surgeon:
    • Surgically place ITB pump
    • Other Intervention
  • Physical & Occupational Therapist:
    • Baseline objective & functional assessment (Incl. digital video)
    • Assist in goal setting
    • Post medical intervention (Oral Meds., Botox, ITB, etc.) rehabilitation
    • Objective & functional outcome data
  • Clinical Specialist/ Vendor Representative
    • Provides clinical assessment
    • Assist in set-up of trials if appropriate.

Spasticity Treatments/Interventions

  • Oral Spasticity Medications
  • Botox injections for isolated muscle groups with increase tone.
  • Trial "Test" nerve blocks using local anesthetics
  • Chemoneurolysis with Phenol (Nerve Block/Motor Point Injections)
  • Intrathecal medications (Intrathecal Baclofen)
  • Physical & Occupational Therapy
    1. Neuro-muscular re-ed/Specific strengthening

    2. Stretching/ROM/Contracture Management

    3. Gait training/High level balance training

    4. Orthoses and casting

    5. Wheelchair seating & positioning

    6. Modalities as needed

Clinic Process: A Team Approach

Step one: Identified for possible Spasticity Intervention

Step two: Referred to Physical and/or Occupational Therapy for Base line assessment and recommendations.

SEE SPASTICTY TEMPLATE

Step Three: Seen at "Initial Spasticity Clinic" by Physician (Neurologist/Physiatrist), Physical & Occupational Therapist, Clinical Vendor Representative. Team reviews all of the information and makes treatment recommendations. Client scheduled for follow-up MD visit for medical intervention and follow-up physical and/or Occupational Therapy if appropriate. Note: The "Initial Spasticity Clinic" is scheduled for 20 minute time slots and is a set day once or twice a month.

Step Four: Medical Intervention. Referred to therapy if appropriate and scheduled for "Follow-up spasticity clinic" in 4 weeks.

Step Five: Initiation of physical and/or occupational therapy following medical intervention

Step Six: Client seen in "Follow-up Spasticity Clinic" by Team. Client's progress reviewed and treatment plan updated. The client is then scheduled for follow-up clinic in 4 or 8 weeks per Team's discretion or discharge from clinic if goals achieved or if further treatment not recommended. "Follow-up clinic visits" scheduled every 15 minutes.

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