Spasticity Slide Library Version All Contents Copyright © WE MOVE 2001 Spasticity Management The Role of Physical and Occupational 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

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

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

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

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

Impairment Dimension Range of motion (ROM) –passive and active –contractures and/or dynamic limitations

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

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

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

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

Functional Limitations, cont’d Sitting Transfers: home, school, work, community Ambulation

Disability Dimension Mobility: work, school, community Communication Sports, recreation and play

Spasticity Slide Library Version 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

Functional Training Self care activities Bed mobility Coming to sit; balance and mobility Transfer training

Functional Training, cont’d Wheelchair mobility Gait training Advanced ambulation skills Skills for recreation, sports Communication skills

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

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

Positioning Splints Upper and lower extremity Passive or dynamic Dynamic brace + ES

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

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

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

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

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