SPASTICITY

SPASTIKOS : from the greek; - TO TUG OR DRAW

MANAGEMENT OF SPASTICITY:

Clinical Assessment

• Objectively assess severity of spasticity by using Ashworth or similar scale.
• Optimize treatment of primary condition.
• Treat other conditions that may exacerbate spasticity.
• Take complete drug history.

ASHWORTH SCALE

• 1 - No increase in tone
• 2 - Slight increase in tone, giving a “catch” when moved in flexion or extension
• 3 - More marked increase in tone but affected part(s) easily flexed
• 4 - Considerable increase in tone; passive movement difficult
• 5 - Affected part(s) rigid in flexion or extension
  

SPASM SCALE

• 0 - No spasms
• 1 - No spontaneous spasms (except with vigorous motor stimulation)
• 2 - Occasional spontaneous spasms and easily induced spasms
• 3 - More than 1 but less than 10 spontaneous spasms per hour
• 4 - More than 10 spontaneous spasms per hour
  

THE CONSEQUENCES OF SPASTICITY:

• Contractures may develop.
• Spasticity may result in chronic, disabling pain.
• Spasticity negatively impacts on patients “quality of life”:
  • mobility
  • cosmesis
  • hygiene
  • self-esteem
  • self-care
  • affect & mood
  • sleeping patterns
  • sexual function
    

BENEFITS OF SPASTICITY

• Increase functional mobility
• Increase bowel, bladder, sexual function
• Increase circulation, decrease risk of deep vein thrombophlebitis (DVT)
• Decrease muscle atrophy
• Improve respiratory function
• Possible assist against osteoporosis
• Alert to noxious stimulus

DETRIMENTS OF SPASTICITY

• Decrease functional mobility
• Increase skin breakdown secondary to shearing
• Joint contractures
• Decrease respiratory function secondary to deformity
• Increase urinary tract infection
• Increase autonomic dysreflexia
• Increase need for attendant care
• Pain

GOALS OF THERAPY

• Improve functional ability & independence
• Improve indepence with ADL's
• Decrease pain
• Prevent or decrease contractures and skeletal deformities
• Improve skin integrity
• Improve fit and function of orthosis and splints
• Improve position, stabilization, and function in wheelchair
• Ease ambulation
• Facilitate hygiene
• Improve bladder management
• Ease rehabilitation procedures
• Save care giver’s time
  

Select the therapy based on the therapeutic objectives;
select the treatment with the fewest side effects;
Consider both the patient’s and the care giver’s goals.