1. www.wemove.org Spasticity Slide Library Version 2.3 - All Contents Copyright © WE MOVE 2001 Spasticity Management The Role of Physical and Occupational Therapy Part 3 of 6

2. Prior to Intervention Assess baseline status Select appropriate patients Determine goals of treatment Educate patient and family Coordinate with team members www.wemove.org

3. 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 www.wemove.org

4. 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 www.wemove.org

5. 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 www.wemove.org

6. Spasticity Slide Library Version 2.3 - All Contents Copyright © WE MOVE 2001 PT/OT Assessment and Goal Setting

7. Impairment Dimension Range of motion (ROM) –passive and active –contractures and/or dynamic limitations www.wemove.org

8. Impairments, cont’d Muscle tone - patient may use spasticity for support in functional activities Synergies, selective control Strength - reduction in spasticity can unmask weakness www.wemove.org

9. Impairments, cont’d Balance Endurance, energy costs Positioning –bed –sitting (chair,wheelchair,car) –classroom –home www.wemove.org

10. Impairments, cont’d Presence of abnormal developmental reflexes Delayed or incomplete integration of normal reflexes Absence of age-appropriate equilibrium and righting reactions www.wemove.org

11. Functional Limitations Dimension Head control Hand to mouth, grasp/release Self-care: age appropriate skills in grooming, bathing, dressing, feeding Bed mobility www.wemove.org

12. Functional Limitations, cont’d Sitting Transfers: home, school, work, community Ambulation www.wemove.org

13. Disability Dimension Mobility: work, school, community Communication Sports, recreation and play www.wemove.org

14. Spasticity Slide Library Version 2.3 - All Contents Copyright © WE MOVE 2001 Physical and Occupational Therapy: Treatment Options

15. Therapeutic Exercise Stretching and range of motion Myofascial and joint mobilization Active assistive, active and resistive exercise Facilitate useful co-contraction Endurance training www.wemove.org

16. Functional Training Self care activities Bed mobility Coming to sit; balance and mobility Transfer training www.wemove.org

17. Functional Training, cont’d Wheelchair mobility Gait training Advanced ambulation skills Skills for recreation, sports Communication skills www.wemove.org

18. 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 www.wemove.org

19. Bracing AFOs most common lower extremity brace With spasticity, may need to change bracing Consider skin tolerance and wearing time www.wemove.org

20. Positioning Splints Upper and lower extremity Passive or dynamic Dynamic brace + ES www.wemove.org

21. Serial Casting Adjunct to pharmacological intervention, chemodenervation Can aid in gaining ROM Short-leg casts with dorsiflexion cut-out www.wemove.org

22. Equipment The therapist’s role includes: Evaluation of need Preparation of funding justification Instruction of patient and family in use and maintenance www.wemove.org

23. Seating Systems Enhance mobility, cognitive, and communication skills Provide interaction with environment Maximize upper extremity and respiratory function Minimize deformity and skin problems www.wemove.org

24. ADL and Mobility Equipment Examples of ADL and mobility equipment include: Modified eating utensils Bathtub lifts and bathing aids Orthoses and walkers Wheelchairs www.wemove.org

25. Safety Issues Abrupt changes in tone require attention to safety issues Re-evaluate equipment, bracing and splinting Assess and re-teach transfers www.wemove.org