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Management of spasticity in stroke
1Rheumatology and Rehabilitation Research Unit, University of Leeds, UK.
British Medical Bulletin
|November 25, 2000
Summary
Effective spasticity management requires addressing multiple impairments and pain, prioritizing physical therapy and orthoses in acute care. Combining interventions for weakness and spasticity is key for functional gains.
Area of Science:
- Neurology
- Rehabilitation Medicine
- Physical Therapy
Background:
- Spasticity management requires a holistic approach, considering co-occurring impairments and defining functional goals before intervention.
- Factors like muscle co-contraction, involuntary movements, exaggerated reflexes, and pain can exacerbate spasticity and must be identified.
Purpose of the Study:
- To review current spasticity management strategies within acute rehabilitation.
- To evaluate the efficacy of various interventions, including physical therapy, orthoses, botulinum toxin, phenol chemodenervation, muscle strengthening, and electrical stimulation.
Main Methods:
- Literature review of spasticity treatments in acute rehabilitation.
- Analysis of the role of physical therapy, orthoses, and pharmacologic/procedural interventions.
- Consideration of adjunctive therapies like electrical stimulation and muscle strengthening.
Main Results:
- Physical therapy and conventional orthoses are primary treatments during acute rehabilitation.
- Botulinum toxin requires further evaluation for acute settings; phenol chemodenervation is effective for refractory cases.
- Muscle strengthening may benefit chronic hemiparesis without increasing tone; electrical stimulation can be an adjunct.
Conclusions:
- Integrated treatment addressing multiple impairments, including weakness and spasticity, is crucial for achieving functional benefits.
- Identifying and managing exacerbating factors like pain is essential for successful spasticity treatment.