03 spass

25
www.wemove.org Spasticity Slide Library Version 2.3 - All Contents Copyright © WE MOVE 2001 Spasticity Management The Role of Physical and Occupational Therapy Part 3 of 6

Upload: norma-obaid

Post on 30-Apr-2015

956 views

Category:

Economy & Finance


1 download

DESCRIPTION

Spasticity

TRANSCRIPT

Page 1: 03 Spass

www.wemove.org

Spasticity Slide Library Version 2.3 - All Contents Copyright © WE MOVE 2001

Spasticity ManagementThe Role of Physical

andOccupational Therapy

Part 3 of 6

Page 2: 03 Spass

Prior to Intervention

• Assess baseline status

• Select appropriate patients

• Determine goals of treatment

• Educate patient and family

• Coordinate with team members

www.wemove.org

Page 3: 03 Spass

After the Intervention

• Provide active PT/OT treatment and ongoing evaluation

• Follow-up on home program

• Continue to educate patient and family

• Assess treatment outcomes

www.wemove.org

Page 4: 03 Spass

Framework for Assessment

• NCMRR framework – Developed by National Advisory Board of the

National Center for Medical Rehabilitation Research at NIH

– Adopted by the American Physical Therapy Association

– Addresses five dimensions of the disabling process

www.wemove.org

Page 5: 03 Spass

Five Dimensions of the Disabling Process

• Pathophysiology: molecular or cellular • Impairment: organ/system

• Functional limitations: whole body or segmental

• Disability: dysfunction in daily roles

• Societal limitations: potential is limited due to societal barriers

www.wemove.org

Page 6: 03 Spass

www.wemove.org

Spasticity Slide Library Version 2.3 - All Contents Copyright © WE MOVE 2001

PT/OT Assessmentand

Goal Setting

Page 7: 03 Spass

Impairment Dimension

• Range of motion (ROM)

–passive and active

–contractures and/or dynamic limitations

www.wemove.org

Page 8: 03 Spass

Impairments, cont’d

• Muscle tone - patient may use spasticity for support in functional activities

• Synergies, selective control

• Strength - reduction in spasticity can unmask weakness

www.wemove.org

Page 9: 03 Spass

Impairments, cont’d

• Balance

• Endurance, energy costs

• Positioning– bed– sitting (chair,wheelchair,car)– classroom– home

www.wemove.org

Page 10: 03 Spass

Impairments, cont’d

• Presence of abnormal developmental reflexes

• Delayed or incomplete integration of normal reflexes

• Absence of age-appropriate equilibrium and righting reactions

www.wemove.org

Page 11: 03 Spass

Functional Limitations Dimension

• Head control

• Hand to mouth, grasp/release

• Self-care: age appropriate skills in grooming, bathing, dressing, feeding

• Bed mobility

www.wemove.org

Page 12: 03 Spass

Functional Limitations, cont’d

• Sitting

• Transfers: home, school, work, community

• Ambulation

www.wemove.org

Page 13: 03 Spass

Disability Dimension

• Mobility: work, school, community

• Communication

• Sports, recreation and play

www.wemove.org

Page 14: 03 Spass

www.wemove.org

Spasticity Slide Library Version 2.3 - All Contents Copyright © WE MOVE 2001

Physical and Occupational Therapy: Treatment Options

Page 15: 03 Spass

Therapeutic Exercise

• Stretching and range of motion

• Myofascial and joint mobilization

• Active assistive, active and resistive exercise

• Facilitate useful co-contraction

• Endurance training

www.wemove.org

Page 16: 03 Spass

Functional Training

• Self care activities• Bed mobility• Coming to sit; balance and

mobility• Transfer training

www.wemove.org

Page 17: 03 Spass

Functional Training, cont’d

• Wheelchair mobility

• Gait training

• Advanced ambulation skills

• Skills for recreation, sports

• Communication skills

www.wemove.org

Page 18: 03 Spass

Modalities

Must be individualized and not always indicated:

• Heat, cold, biofeedback

• Electrical stimulation (NMES, FES, TES)– Efficacy not well documented– Utilized to:

• Stimulate a weak agonist

• Reduce spasticity in antagonist

www.wemove.org

Page 19: 03 Spass

Bracing

• AFOs most common lower extremity brace

• With spasticity, may need to change bracing

• Consider skin tolerance and wearing time

www.wemove.org

Page 20: 03 Spass

Positioning Splints

• Upper and lower extremity

• Passive or dynamic

• Dynamic brace + ES

www.wemove.org

Page 21: 03 Spass

Serial Casting

• Adjunct to pharmacological intervention, chemodenervation

• Can aid in gaining ROM

• Short-leg casts with dorsiflexion cut-out

www.wemove.org

Page 22: 03 Spass

Equipment

The therapist’s role includes:

• Evaluation of need

• Preparation of funding justification

• Instruction of patient and family in use and maintenance

www.wemove.org

Page 23: 03 Spass

Seating Systems

• Enhance mobility, cognitive, and communication skills

• Provide interaction with environment

• Maximize upper extremity and respiratory function

• Minimize deformity and skin problems

www.wemove.org

Page 24: 03 Spass

ADL and Mobility Equipment

Examples of ADL and mobility equipment include:

• Modified eating utensils

• Bathtub lifts and bathing aids

• Orthoses and walkers

• Wheelchairs

www.wemove.org

Page 25: 03 Spass

Safety Issues

• Abrupt changes in tone require attention to safety issues

• Re-evaluate equipment, bracing and splinting

• Assess and re-teach transfers

www.wemove.org