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I -Optimizing Spasticity

Current Canadian Practice Profile: Optimizing Spasticity after SCI Figure 2.0 a simplified ilustration of the interelationships betwen services that provides an overview of the spectrum of multi -modal services available to optimize spasticit y, post-SCI. Interprofessional assessment of spas��city Pa��ent/caregiver (e.g. individualized) Func��onal goals Physical interven��ons (e.g. PT/OT) goals Medical (e.g. pharmacological) (e.g. ADL) Surgical (e.g. neurolysis) Educa��on (e.g. enhanced self-management) Figure 2.0 key PRACTICE referenceS No SCI specific clinical practice guidelines (CPGs) are available. 1. Walker HW, Kirshblum S. Spasticity due to disease of the spinal cord: pathophysiology, epidemiology, and treatment. In: Brashear A, Elovic E, eds. Spasticity: Diagnosis and Management. New York, NY: Demos Medical Publishing; 2010:313-40. 2. Hsieh JTC, Wolfe DL, Townson AF, et al. Spasticity following spinal cord injury. In: Eng JJ, Teasell RW, Miller WC, et al., eds. Spinal Cord Injury Rehabilitation Evidence. Version 3.0. Vancouver, BC; 2010. 3. Hsieh J, Wolfe DL, Connolly S, et al. Spasticity after spinal cord injury: an evidence-based review of current interventions. Top Spinal Cord Inj Rehabil. 2007;13(1):81-97. 4. Adams MM, Hicks AL. Spasticity after spinal cord injury. Spinal Cord. 2005;43(10):577-86. 5. Satkunam LE. Rehabilitation medicine: 3. Management of adult spasticity. CMAJ. 2003;169 (11):1173-9. 6. Rosche J. Treatment of spasticity. Spinal Cord. 2002;40(6):261-2. 7. Ward AB. A summary of spasticity management-a treatment algorithm. Eur J Neurol. 2002;9(Suppl 1):48-52. 8. Al-Khodairy AT, Gobelet C, Rossier AB. Has botulinum toxin type A a place in the treatment of spasticity in spinal cord injury patients? Spinal Cord. 1998;36:854-8. 9. Krishnan RV. A new extra-vertebral treatment model for incomplete spinal cord injuries. Intern J Neuroscience. 2003;113:165-77. Care Pathwa ys or Local Protocols All sites report that spasticity optimization is managed on site with 58% (7/12) using a treatment protocol, and 17% (2/12) having a standard of care. Interestingly, 33% (4/12) report using a CPG, although chapter authors did not find peer-reviewed published CPGs. Assessments 1. Number of sites reporting use of wound assessment tools any use/routine use for: a. Characterization and/evaluation of spasticity • Modified Ashworth and Ashworth 100/42% and 25/0% • Penn Spasm Frequency and Severity Scale (SFSS) 58/8% • Visual Analogue Scale (VAS) for spasticity 42/8% • Pendulum 33% for research purposes only • Other measures such as Goal Attainment Scaling (GAS), Tardieu Scale, Range of Motion (ROM) measurement and Numeric Rating Scale are noted by a single site, with only ROM measurement and the Numeric Rating Scale for spasticity used routinely at one site. • Interestingly, the Spinal Cord Assessment Tool for Spasticity (SCATS) and SCI Spasticity Evaluation Tool (SCI-SET), available in the peer-reviewed published literature (albeit in the early stages of psychometric validation), have not yet been adopted, even for research purposes. Due to the multidimensional nature of spasticity, no single outcome measure can encapsulate the extent of spasticity impact, for a holistic approach to treatment. Consensus has not yet been achieved for the determination of clinically meaningful, feasible and effective outcome measures. Currently, a multidimensional test battery is likely the way forward, the intent of SCATS and SCI-SET. Practice leaders from sites with dedicated spasticity clinics, use numeric rating scale/visual analogue scales (NRS/VAS) to document the functional implication of spasticity, and to describe spasticity severity. The goal attainment scale is used to evaluate achievement of the stated rehabilitation goals, prior to intervention. 94 CAPTURING CAPACITY IN CANADIAN SCI REHABILITATION


I -Optimizing Spasticity
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