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Botox for Spasticity – How I do it

Why is spasticity important ?

•Spasticity is a motor disorder charaterized by a velocity dependant increase in the tonic stretch reflex
•In simpler terms, increased tone or spasticity is the tightness that patients &/or caregivers report with passive movements of the limb
•Regardless of its cause, spasticity causes significant disability
•The treatment of spasticity relies on the physician’s assessment of the patient as well as with conversations with the caregiver.

When is spasticity significant ?

•Spasticity is a clinically relevant medical problem when it interferes with function or care of the patients
•The lesion alone does not predict the extent or impact of spasticity
•Other factors such as medications, stress, medical illness, timing of therapy and so on impact the clinical outcome

Choices of treatment of spasticity

•Several options are available for the treatment of spasticity
•Splinting, stretching through physical therapy
•Chemoneurolysis with phenol/alcohol
•Oral medications such as Dantrolene Sodium, Diazepam, Baclofen, etc
•Botulinum toxin injections
•Baclofen pump
•Rhizotomy

The UMN syndrome

•The commonest cause of spasticity one sees in neurology is the upper motor neuron syndrome
•It is the aggregate of positive and negative signs that occur after an upper motor neuron lesion
•Negative signs are due to loss of a function ordinarily controlled by the lesioned area of brain
•Positive signs reflect release phenomena, abnormal or exaggerated behaviours and loss of inhibition
•Positive and negative signs often interact at the same time

Assessment of Spasticity

•Measures of spasticity include measures of passive movement, measures of voluntary activity, passive and active function,quality of life measures
•Outcome measures to assess intervention effectiveness could include all of the above plus certain specific assessments
•However, to date there is no reliable, specific objective measure available,

Assessment tools

•Measures using nerve conduction and EMG
•Tendon reflexes
•Measures of passive activity such as the Ashworth scale, modified Ashworth scale and modified modified Ashworth scale, Tardieu scale,Range of motion,Stiffness and muscle tone,Stretch and stretch reflexes,Pendulum test models,Reflex threshold angle
•Measures of voluntary activity – performance based measures, gait, balance
•Functional measures

Modified Ashworth Scale

•0 – No increase in muscle tone
•1 – Slight increase in muscle tone manifested at end of ROM
•2 – Marked increase in muscle tone manifested by a catch in the middle range and resistance throughout the remainder of the ROM, but affected part (s) easily moved
•3 – Considerable increase in muscle tone, passive movement is difficult
•4 – Affected part is rigid in flexion or extension

FOR TYPES OF CEREBRAL PALSY - CLICK HERE