03 Spass


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  • Physical and occupational therapists (PT/OT) play a critical role in the assessment and treatment of patients with spasticity resulting from a variety of etiologies. This section of the slide kit specifically addresses the PT/OT program for patients who are undergoing medical or surgical intervention for spasticity. Interventions may include oral medications, chemodenervation with phenol or botulinum toxin, implantation of an intrathecal baclofen pump, and neurosurgical procedures such as selective posterior rhizotomy and orthopedic surgery.
  • 03 Spass

    1. 1. Spasticity Management The Role of Physical and Occupational Therapy Part 3 of 6
    2. 2. Prior to Intervention <ul><li>Assess baseline status </li></ul><ul><li>Select appropriate patients </li></ul><ul><li>Determine goals of treatment </li></ul><ul><li>Educate patient and family </li></ul><ul><li>Coordinate with team members </li></ul>www.wemove.org
    3. 3. After the Intervention <ul><li>Provide active PT/OT treatment and ongoing evaluation </li></ul><ul><li>Follow-up on home program </li></ul><ul><li>Continue to educate patient and family </li></ul><ul><li>Assess treatment outcomes </li></ul>www.wemove.org
    4. 4. Framework for Assessment <ul><li>NCMRR framework </li></ul><ul><ul><li>Developed by National Advisory Board of the National Center for Medical Rehabilitation Research at NIH </li></ul></ul><ul><ul><li>Adopted by the American Physical Therapy Association </li></ul></ul><ul><ul><li>Addresses five dimensions of the disabling process </li></ul></ul>www.wemove.org
    5. 5. Five Dimensions of the Disabling Process <ul><li>Pathophysiology: molecular or cellular </li></ul><ul><li>Impairment: organ/system </li></ul><ul><li>Functional limitations: whole body or segmental </li></ul><ul><li>Disability: dysfunction in daily roles </li></ul><ul><li>Societal limitations: potential is limited due to societal barriers </li></ul>www.wemove.org
    6. 6. PT/OT Assessment and Goal Setting
    7. 7. Impairment Dimension <ul><li>Range of motion (ROM) </li></ul><ul><ul><li>passive and active </li></ul></ul><ul><ul><li>contractures and/or dynamic limitations </li></ul></ul>www.wemove.org
    8. 8. Impairments, cont’d <ul><li>Muscle tone - patient may use spasticity for support in functional activities </li></ul><ul><li>Synergies, selective control </li></ul><ul><li>Strength - reduction in spasticity can unmask weakness </li></ul>www.wemove.org
    9. 9. Impairments, cont’d <ul><li>Balance </li></ul><ul><li>Endurance, energy costs </li></ul><ul><li>Positioning </li></ul><ul><ul><li>bed </li></ul></ul><ul><ul><li>sitting (chair,wheelchair,car) </li></ul></ul><ul><ul><li>classroom </li></ul></ul><ul><ul><li>home </li></ul></ul>www.wemove.org
    10. 10. Impairments, cont’d <ul><li>Presence of abnormal developmental reflexes </li></ul><ul><li>Delayed or incomplete integration of normal reflexes </li></ul><ul><li>Absence of age-appropriate equilibrium and righting reactions </li></ul>www.wemove.org
    11. 11. Functional Limitations Dimension <ul><li>Head control </li></ul><ul><li>Hand to mouth, grasp/release </li></ul><ul><li>Self-care: age appropriate skills in grooming, bathing, dressing, feeding </li></ul><ul><li>Bed mobility </li></ul>www.wemove.org
    12. 12. Functional Limitations, cont’d <ul><li>Sitting </li></ul><ul><li>Transfers: home, school, work, community </li></ul><ul><li>Ambulation </li></ul>www.wemove.org
    13. 13. Disability Dimension <ul><li>Mobility: work, school, community </li></ul><ul><li>Communication </li></ul><ul><li>Sports, recreation and play </li></ul>www.wemove.org
    14. 14. Physical and Occupational Therapy: Treatment Options
    15. 15. Therapeutic Exercise <ul><li>Stretching and range of motion </li></ul><ul><li>Myofascial and joint mobilization </li></ul><ul><li>Active assistive, active and resistive exercise </li></ul><ul><li>Facilitate useful co-contraction </li></ul><ul><li>Endurance training </li></ul>www.wemove.org
    16. 16. Functional Training <ul><li>Self care activities </li></ul><ul><li>Bed mobility </li></ul><ul><li>Coming to sit; balance and mobility </li></ul><ul><li>Transfer training </li></ul>www.wemove.org
    17. 17. Functional Training, cont’d <ul><li>Wheelchair mobility </li></ul><ul><li>Gait training </li></ul><ul><li>Advanced ambulation skills </li></ul><ul><li>Skills for recreation, sports </li></ul><ul><li>Communication skills </li></ul>www.wemove.org
    18. 18. Modalities <ul><li>Must be individualized and not always indicated: </li></ul><ul><li>Heat, cold, biofeedback </li></ul><ul><li>Electrical stimulation (NMES, FES, TES) </li></ul><ul><ul><li>Efficacy not well documented </li></ul></ul><ul><ul><li>Utilized to: </li></ul></ul><ul><ul><ul><li>Stimulate a weak agonist </li></ul></ul></ul><ul><ul><ul><li>Reduce spasticity in antagonist </li></ul></ul></ul>www.wemove.org
    19. 19. Bracing <ul><li>AFOs most common lower extremity brace </li></ul><ul><li>With spasticity, may need to change bracing </li></ul><ul><li>Consider skin tolerance and wearing time </li></ul>www.wemove.org
    20. 20. Positioning Splints <ul><li>Upper and lower extremity </li></ul><ul><li>Passive or dynamic </li></ul><ul><li>Dynamic brace + ES </li></ul>www.wemove.org
    21. 21. Serial Casting <ul><li>Adjunct to pharmacological intervention, chemodenervation </li></ul><ul><li>Can aid in gaining ROM </li></ul><ul><li>Short-leg casts with dorsiflexion cut-out </li></ul>www.wemove.org
    22. 22. Equipment <ul><li>The therapist’s role includes: </li></ul><ul><li>Evaluation of need </li></ul><ul><li>Preparation of funding justification </li></ul><ul><li>Instruction of patient and family in use and maintenance </li></ul>www.wemove.org
    23. 23. Seating Systems <ul><li>Enhance mobility, cognitive, and communication skills </li></ul><ul><li>Provide interaction with environment </li></ul><ul><li>Maximize upper extremity and respiratory function </li></ul><ul><li>Minimize deformity and skin problems </li></ul>www.wemove.org
    24. 24. ADL and Mobility Equipment <ul><li>Examples of ADL and mobility equipment include: </li></ul><ul><li>Modified eating utensils </li></ul><ul><li>Bathtub lifts and bathing aids </li></ul><ul><li>Orthoses and walkers </li></ul><ul><li>Wheelchairs </li></ul>www.wemove.org
    25. 25. Safety Issues <ul><li>Abrupt changes in tone require attention to safety issues </li></ul><ul><li>Re-evaluate equipment, bracing and splinting </li></ul><ul><li>Assess and re-teach transfers </li></ul>www.wemove.org