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I -Optimizing Spasticity

Canadians Likely to Influence Practice in the Next Five Years 1. Chris Boulias, MD (Physiatry), Toronto: Explores the interrelationship between pain and spasticity. 2. Allan Casey, MD (Physiatry), Winnipeg: Extensive experience in the long-term management of individuals with an Intrathecal pump. 3. Cathy Craven, MD (Physiatry), Toronto: Evaluates the psychometric properties of a new method for quantifying spasticity using a shape–tape. 4. Karen Ethans, MD (Physiatry), Winnipeg: Extensive experience with a variety of pumps, and an expert mentor for colleagues across the country. 5. Monica Gorassini, PhD (Physiology), Edmonton: Explores the role of intrathecal 5-Hydroxytryptophan (5-HT). 6. Jane Hsieh, MSc, Toronto: Extensive experience leading implementation of multicentre trials to evaluate the efficacy of fampridine, among individuals with chronic SCI, that can be used to inform future multi-site initiatives. 7. Tom Miller, MD (Physiatry), London: Leads the development of a new spasticity outcome measure. 8. Lalith Satkunum, MD (Physiatry), Edmonton: Explores muscle anatomy and the implications for service delivery, and is developing an iPad application of a visual analogue scale to document spasticity frequency and severity. 9. Christine Short, MD (Physiatry), Halifax: Assists with the evaluation of the role of fampridine to augment gait performance, among individuals with incomplete SCI and significant spasticity. Emerging Practices for the Optimization of Spasticity in SCI 1. Botulinum toxin for the augmentation of gait in individuals with motor incomplete SCI. 2. The role of cannabinoids as alternate or adjunct therapy, for spasticity. 3. Dalfampridine (4-aminopyridine), establishing research protocols to demonstrate treatment efficacy and effectiveness. 4. Elimination of the regional disparity in Baclofen pump provision. 5. The role of whole body vibration to reduce spasticity. 6. The role of Functional Electrical Stimulation (FES) and exoskeletons to reduce spasticity. 7. Constraint-induced movement therapy, including evidence describing the frequency and intensity of range of motion, stretching exercises and serial casting. 8. Identification of an optimal outcome measure or standard battery of measures, to inform treatment of spasticity, in a holistic fashion. 9. Determination of the adverse sequelae of early Baclofen administration, during subacute rehabilitation. 10. The role of 5-HT in modulation of spinal reflexes that reduce muscle tone. Roadmap: Optimizing Spasticity, Post-SCI Clinical Practice Guidelines (CPGs) for standardized best practices, in the optimization of spasticity treatment, are required. A decent foundation or body of literature already exists, as does the expertise to create an SCI-specific CPG. Missing is funding for such an activity and, therefore, a coordinated request, directed at government and non-governmental (NGO) funding agencies, would provide an immediate way forward. The ultimate goal would be to standardize best practices, with best practice indicators, to objectively measure improvements in patient outcomes. Suggested BEST PRACTICE INDICATORS are: Best Practice Indicators How is it measured? Who measures it? Where? When is it idealy measured? 1. The organization conducts an initial spasticity assessment at admission, using a standardized assessment tool. Counts** Program* Quarterly 2. The organization assesses each client for spasticity-related quality of life issues. Counts** Program* Quarterly 3. The organization implements documented protocols and procedures to spasticity-related to quality of life. Counts Program Quarterly 4. The organization educates patients and staff on risk factors for increased spasticity, and on strategies to minimize spasticity. Counts Program* Quarterly 5. The organization monitors its successful spasticity-related, quality of life improvements. Patient Reported Outcomes Program* Quarterly ** Counts – To name or list the units of a group or frequency of date/event, one by one, in order to determine the total. * Program – Within the local participating SCI rehabilitation programs. 96 CAPTURING CAPACITY IN CANADIAN SCI REHABILITATION


I -Optimizing Spasticity
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