Clinical Evaluation and Management of Spasticity (Current by David A. Gelber, Douglas R. Jeffery

By David A. Gelber, Douglas R. Jeffery

David A. Gelber, MD, and Douglas R. Jeffery, MD, have assembled a much-needed choice of authoritative overview articles discussing the pathophysiology of power neurologic spasticity and detailing its frequently complicated scientific and surgical administration. Written by way of major specialists in neurology and rehabilitation, the e-book covers actual and occupational treatment, splinting and orthotics, electric stimulation, orthopedic interventions, nerve blocks, using botulinum toxin, and novel remedies resembling tizanidine, intrathecal medicines, and neurosurgical thoughts. The individuals additionally evaluation coordinated techniques to the remedy of spasticity and particular neurological ailments resembling spinal wire damage, a number of sclerosis, stroke, cerebral palsy, and worrying mind harm.

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Example text

A cumulative Ashworth score can also be calculated, and is the sum of individual scores for flexion and extension at major joints of each extremity. A score can be calculated for each limb, or a combination of limbs. Although the Ashworth scale is easy to obtain in a clinical setting, it is subjective and more or less dependent on the evaluator. Also, increased resistance to passive movement can be reflex-mediated (reflex hyperexcitability) and/or nonreflex-mediated (soft-tissue resistance). These are not differentiated by the Ashworth scale, but this is an important issue, because different causes of increased resistance may require different treatments.

And Young, R. ), Elsevier Science Publishers BV, The Netherlands. 53. Fung, J. and Barbeau, H. (1989) A dynamic EMG profile index to quantify muscular activation disorder in spastic paretic gait. Electroencephalogr. Clin. Neurophysiol. 73, 233–244. 54. Sutherland, D. H. (1978) Gait analysis in cerebral palsy. Dev. Med. Child Neurol. 20, 807–813. 55. Shapiro, A. et al. (1990) Preoperative and postoperative gait evaluation in cerebral palsy. Arch. Phys. Med. Rehabil. 71, 236–240. 56. Delwaide, P.

Spasticity should be differentiated from rigidity, but as previously mentioned, the two may co-exist. In persons with spasticity, there is usually a difference between resistance in one direction of movement as compared to the opposite direction. In addition, when a joint is moved rapidly, a “spastic catch” owing to activation of the phasic-stretch reflex is often felt. Some persons with spasticity exhibit the “clasped knife” phenomenon, where resistance is perceived through most of passive range of motion, but a sudden “release” is felt towards the end of range.

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