Spasticity - pathogenesis, prevention and treatment strategies

This review of the long-term management of spasticity addresses some of the clinical dilemmas in the management of patients with chronic disability. It is important for clinicians to have clear objectives in patient treatment and the available treatment strategies. The review reiterates the role of physical treatment in the management, and thereafter the maintenance of patients with spasticity. Spasticity is a physiological consequence of an injury to the nervous system. It is a complex problem which can cause profound disability, alone or in combination with the other features of an upper motor neuron syndrome, and can give rise to significant difficulties in the process of rehabilitation. This can be associated with profound restriction to activity and participation due to pain, weakness, and contractures. Optimum management is dependent on an understanding of its underlying physiology, an awareness of its natural history, an appreciation of the impact on the patient, and a comprehensive approach to minimizing that impact. The aim of this article is to highlight the importance, basic approach, and management options available to the general practitioner in such a complex condition

use of botulinum toxin and epidural analgesia for the treatment of spasticity and pain in a patient with maple syrup urine disease

A 7-year-old boy, weighing 18 kg, was diagnosed with maple syrup urine disease [MSUD]. He suffered from spasticity of the lower limbs and pain that did not respond to oral medications. Injections of botulinum toxin A [BTX-A] at 10 sites and epidural analgesia with 0.125% bupivacaine were used to treat spasticity with good results. We conclude that BTX-A combined with epidural analgesia may be a useful treatment option for incapacitating, painful spasticity related to MSUD. This treatment modality allowed a comprehensive rehabilitation program to be completed and it lasted longer than 9 months

Effects of dorsal static splint on spasticity and range of motion of upper extremity of children with cerebral palsy in three time periods

Cerebral Palsy [CP] is a neurodevelopmental disorder caused by non-progressive lesions in single or multiple locations in the immature brain. Lesions of motor cortex and pyramidal tracts can lead to spasticity. Inhibition of spasticity is necessary to increase extremity mobilization, prevent postural abnormalities and provide independence in daily living activities. The purpose of this study was to determine the effects of volar static splint spasticity and range of motion of upper extremity in children with Cerebral palsy in three periods of time. The design of this study was experimental and repeated measurements. Ten children with Cerebral palsy aging 4-6 years old were non-randomly selected among children referred to occupational therapy Clinic of rehabilitation Faculty of Tehran University of Medical Sciences. Children used dorsal static splint for three months [2 hours at day and 4 hours at night]. In this study, Modified Ashworth Scale was used to evaluate spasticity and a Goniometre was used to measure passive range of motion. The results of this study showed significant reduction in the upper limb spasticity after 2 months [p

[Comparison between bobath inhibitory technique with electrical stimulation and bobath inhibitory technique alone on spastic patients]

Spasticity is one the signs of upper motor neuron injuries. Spasticity is as inter ventional factor result in gait, posture and function difficulties. There are different methods to reduce spasticity such as drug therapy, physical therapy, etc. The physical therapists use bobath inhibitory technipues for decreasing spasticity. The relatively new method in treatment of patients with spasticity is electrical stimulation. There are a controversy in results of studies that evaluate the effects of electrical stimulation on spasticity. The purpose of present study is a comparison between bobath technique with electrical stimulation and bobath technique alone on spastic patients. Fourty patients with upper motor lesion who had spasticity in lower extremities participated in the study. The subjects divided into two groups. Group A was received bobath technique with electrical stimulation and group B received only bobath technique. Before and after intervension, the spasticity assessment was performed by measurement of passive dorsiflexion range of motion, Tibialis anterior strength and Gastrocneminus tone with Ashworth scale and H-reflex. The results of this study indicated that the improvement induced by both methods were statistically significant for all parameters measured [p=0.000]. In group A, increasing passive dorsi flexion range of motion and decreasing Gastrocnemius tone was greater than group B. These differentes were statiscally significant [p=0/001]. However, there was no significant difference between two groups with respect to tibialis anterior strength increase and H-reflex activity decrease. To decrease Gastrocnemius tonicity and increase passive dorsi flexion range of motion, bobath inhibitory with electrical stimulation was more effective than inhibitory technique alone