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I -Optimizing Spasticity

Optimizing Spasticity | Body Structure and Function J Hsieh, MSc; L Satkunam, MD; K Ethans, MD; S Kalsi-Ryan, PhD; C Craven, MD; and the E-Scan Investigative Team Spinal cord injury (SCI)-related spasticity is caused by damage to the spinal cord nerve pathways that control muscle movement. This type of damage is the reason for abnormal increases in muscle tone or stiffness that may lead to unwanted movement, discomfort, pain and interference with activities of daily living. Left uncontrolled, spasticity can be the cause of fixed joints (contractures) and injuries, as a result of sudden, awkward movements. The impact of spasticity varies with the extent of the insult to the spinal cord. Spasticity commonly precipitates secondary health conditions, leading to emotional and environmental integration issues, if left unmanaged.1 The increased muscle tone, related to spasticity, can have a negative and/or positive impact on an individual, often with both positive and negative effects occurring in the same individual. As an example, spasticity can sometimes be beneficial for mobility and transfers, but can also be a source of pain, hygiene difficulties, seating problems or sleep disturbance. As well, spasticity can have genderspecific effects such as enhancement/detraction of sexual activity in males and females, respectively.2,3 Forty-one percent of individuals with spasticity, secondary to SCI, report that it is one of the major medical obstacles to community and workplace re-integration.4,5 Assessments of spasticity-related treatment goals must be customized for each individual, their impairment and ability to overcome functional impairments6 (given consideration of the potential protective attributes of spasticity, such as the prevention of skeletal muscle atrophy7), and type II diabetes risk reduction.8 Optimizing spasticity is best achieved through incremental application of the least invasive and most cost- efficient treatments, 9 while objectively measuring clinical- and patient-reported outcomes in multiple domains of everyday life.10 Figure 1.0 Figure 1.0 Distribution of healthcare profesionals providing services for the optimization of spasticit y, in tertiary SCI rehabilitation centres, acros Canada . Current Practice: Optimizing Spasticity Post-SCI Building on the concept of incremental application of the least invasive treatment options, physical (PT) and occupational therapy (OT) are initiated early during rehabilitation, and continue indefinitely, through post-discharge care - either formally through professional follow up or informally through self-management and/or personal caregivers. Physiatrists and family medicine practitioners offer pharmacotherapies, which are thought to be the most efficient treatment for velocitydependent components of spasticity. Surgery and neurolysis are options for the treatment of focal spasticity. An individualized combination of treatment options is often the preferred method of management towards optimization, organized by an interprofessional team comprised of PTs, OTs, doctors (physiatrists, general practitioners and surgeons), nurses and pharmacists. Some institutions report access to additional professionals such as a neurologist, a psychiatrist, orthotist and OT and/ or PT assistants. Figure 1.0 illustrates that, although all rehabilitation facilities report spasticity management services, interprofessional staffing models vary across organizations, with the most consistent management models including PT/OTs, physiatrists and nurses. 0 2 4 6 8 10 12 Family Prac����oner Physician Neurologist Nurse (RN) Occupa��onal Therapist Orthopaedic Surgeon Pharmacist Physiatrist Physiotherapist PTA/Technician Psychiatrist Rehabilita��on Therapist Number of Sites OPTIMIZING SPASTICITY | BODY STRUCTURE AND FNUCTION 93


I -Optimizing Spasticity
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