sever spastic patient

Hi,

I have a old man (Patient) with sever spastic pattern in all body (extension spasm in left side & flex. spasm in right side). Is there any physio help with how to deal with him? thanks

[sdkashif]

A variety of strategies are available for the management of spasticity. Physiotherapy is the most traditional form of treatment. These treatments are designed for

1- To reduce muscle tone.

2-Maintain or improve range of motion and mobility

3- Increase strength and coordination, and improve comfort.

The choice of treatments is individualized to meet the needs of the person with spasticity. Treatments may include any of the following:

Exercises:

Stretching Exercises:

Stretching forms the basis of spasticity treatment. Stretching helps to maintain the full range of motion of a joint and helps prevent contracture.

Strengthening Exercises:

Strengthening exercises are aimed at restoring the proper level of strength to affected muscles, so that as tone is reduced through other treatments, the affected limb can be used to its fullest potential. As yet no clear evidence exists that intensive physiotherapy (1 h a day, 5 days a wk) is more beneficial than routine physiotherapy (6-7 h over 3 mo).

Development of Motor Control:

It is said that if a motor control or power is developed in the spastic limb, the spasticity is reduced automatically.


Use of Orthoses:

Application of orthoses, casts, and braces allows a spastic limb to be maintained in a more normal position. For instance, an ankle-foot orthosis can help keep the foot flexed and reduce contracture of the calf muscles. A cast is a temporary brace, and serial casting gradually stretches out a contractured limb through the application of successive casts. Proper limb positioning improves comfort and reduces spasticity.

Physical Modalities:

Cold Therapy or Cryotherapy:

Brief application of cold packs to spastic muscles may be used to improve tone and function for a short period of time or to ease pain.

Heat:

Superficial and/ or deep heating methods are both effective in reducing the spasticity. Although superficial heating methods Infra reds are more effective in reducing the spasticity.

Use of Electrical Stimulation:

Both Neuromuscular electrical stimulation and functional electrical stimulation are effective in reducing the spasticity.
Electrical stimulation may be used to stimulate a weak muscle to oppose the activity of a stronger, spastic one. It also may reduce spasticity for short periods of time. Electrical stimulation is used most often to help flex the ankle for walking, and to help extend spastic fingers.

Biofeedback:

Biofeedback is the use of an electrical monitor that creates a signal, usually a sound, as a spastic muscle relaxes. In this way, the person with spasticity may be able to train himself to reduce muscle tone consciously, and this may play a modest role in reducing spasticity.

Also have a look over these information resources.

The role of the specialist physiotherapist in the management of spasticity

Spasticity- Neurological Physiotherapy

The Use of Hydrotherapy for the Management of Spasticity

Managing Spasticity in People With Multiple Sclerosis

Ankle Muscle Activity Before and After Botulinum Toxin Therapy for Lower Limb Extensor Spasticity in Chronic Hemiparetic Patients

Spasticity after Stroke- Why Bother?

Clinical Practice Guidelines for Adult Stroke Physiotherapy

Spasticity after Stroke- What's the catch?

Managment of Adult Stroke- Physiotherapy Guidelines

Spasticity after Stroke- It occurance and Association with motor impairment

Role of lower limbs extensor over activity in Stroke

Reflex inhibiting postures

[ikreuzer]

can you give us some more information? How old is this gentleman? What are the pathologies? Is he ambulant, etc?
neving

[physiobob]

Originally Posted by saeidphysio

Hi,

I have a old man (Patient) with sever spastic pattern in all body (extension spasm in left side & flex. spasm in right side). Is there any physio help with how to deal with him? thanks

I agree that we need to know a little more about his main issues? Is he post stroke? post head injury? In general maybe take a Bobath approach to assessment. This would include things like looking at the effect of his spasticity in sitting (compared to standing or walking). When in sitting vary the amount of support to his pelvis and trunk to see if thie affects the tone in the effected limbs. e.g. maybe his sitting reduces his stasticity compared with standing or walking. If this is so then you have a starting point i.e. improve sitting balance first - reaching from sitting, perhaps sitting on a gymball with varying amounts of support. You can be pretty creative to see what reduces and what increases the tone. In this way you can see what is compensatory strategy or 'reflexive' tonal increases and what is more under higher control.

Please keep us informed and let us know you results so we can all provide more strategies. This might even include things such as botox...

[vasanth]

There are numerous methods to reduce spasticity.
But which PT Technique works?
Unfortunately other than functional exercises, the other inhibitory techniques carry poor evidence in support of improvement.
A patient with stroke eventhough presenting with spasticity is affected by numerous other impairments. Hence a stroke patient should not be viewed as only spastic . Muscle strength is one such impairment that has been said to occur in most stroke patients. But because of the heavy influence of Bobath technique our mind set has not changed away from that of spasticity. Hence if the goal of therapy is targeted towards more functional activities can benefit the patient.

[ikreuzer]

Hi Saeidphysio,

you ask specifically how to deal with your "old patient...", can you give us more information, please.
What is your goal, are you trying to make him comfortable, are you hoping for improvement of function. is he bed-bound, ambulating, what is his mental status, is he at home, and how old is he?
Also, please elaborate on the spasticities, what are the pathologies that produced this very unusual picture, what are we dealing with here? Whjere exactly is the spasticity, which muscles are effected, any contractures, how longstanding is this condition, any clonus, tremors, rigidities, etc?
I am really intrigued by this picture, and would really like to know more.
IK