Spasticity - Pathogenesis, prevention and treatment strategies

Abstract

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.

Comparison between Erigo tilt-table exercise and conventional physiotherapy exercises in acute stroke patients: a randomized trial

“…Full range of motion (ROM) exercisespassive and active-assisted range of motion exercises for the upper limb including shoulder (flexion, extension, abduction and adduction), elbow (flexion and extension), forearm (supination and pronation), wrist (flexion, extension, radial and ulnar deviation), and for the lower limb including hip (flexion, extension, abduction and adduction), knee (flexion and extension), ankle (dorsiflexion, plantar flexion, eversion and inversion). For spasticity management -Positioning of the limb, prolonged icing, brushing, gentle stroking, and gentle tapping [17][18][19] Common mat activities including turning from supine to side-lying to prone and vice versa, prone to prone on an elbow, prone on elbow to prone on hand; prone on hand to quadruped; quadruped to kneeling; kneeling to half-kneeling; half kneeling to standing with support; standing with support to the standing without support. Bridging exercises.…”

Solubility and Stability of Baclofen 3 mg/mL Intrathecal Formulation and Its Compatibility With Implantable Programmable Intrathecal Infusion Systems

“…Spasticity is a frequent consequence of neurotrauma, stroke, and degenerative neurologic diseases (1)(2)(3)(4)(5). Orally-administered treatments are used frequently in the management of patients with spasticity, but these treatments may have important limitations with respect to efficacy, safety, and dosing (4,(6)(7)(8)(9). Intrathecal (IT) baclofen has been shown to be efficacious for treatment of spasticity that is not well controlled with oral agents (10,11).…”

Spasticity and Intrathecal Baclofen

“…10,13 The duration between the injury and the appearance of spasticity varies from days to months, but permanent loss of joint range has been known to occur within 3 to 6 weeks after stroke and other acute brain injuries. 2,14,15 The hemiplegic stroke literature supports a time frame for motor recovery that is active within the first 3 to 6 months, then arrests or plateaus within 6 to 12 months following most strokes. [16][17][18] Changes in muscle tone and reflex patterns after a stroke-like CNS injury may parallel this recovery process, implying that improvement in spastic tone after a stroke is unlikely after 6 months without effective therapeutic interventions.…”