How Can We Improve Current Practice in Spastic Paresis?

Abstract

Spastic paresis can arise from a variety of conditions, including stroke, spinal cord injury, multiple sclerosis, cerebral palsy, traumatic brain injury and hereditary spastic paraplegia. It is associated with muscle contracture, stiffness and pain, and can lead to segmental deformity. The positive, negative and biomechanical symptoms associated with spastic paresis can significantly affect patients℉ quality of life, by affecting their ability to perform normal activities. This paper – based on the content of a global spasticity interdisciplinary masterclass presented by the authors for healthcare practitioners working in the field of spastic paresis – proposes a multidisciplinary approach to care involving not only healthcare practitioners, but also the patient and their family members/carers, and improvement of the transition between specialist care and community services. The suggested treatment pathway comprises assessment of the severity of spastic paresis, early access to neurorehabilitation and physiotherapy and treatment with botulinum toxin and new technologies, where appropriate. To address the challenge of maintaining patients℉ motivation over the long term, tailored guided self-rehabilitation contracts can be used to set and monitor therapeutic goals. Current global consensus guidelines may have to be updated, to include a clinical care pathway related to the encompassing management of spastic paresis.

Waggle needling wields preferable neuroprotective and anti-spastic effects on post-stroke spasticity rats by attenuating γ-aminobutyric acid transaminase and enhancing γ-aminobutyric acid.

“…Post-stroke spasticity induced abnormal postures and movement patterns hinder the rehabilitation process of patients [3], indicating the earlier the proper intervention apply, the better the curative effects will easily obtain. As a convenient and economic therapy, acupuncture could effectively counteract spasticity following stroke [8].…”

“…These changes can lead to α-motor neurons hyperexcitability and thus excessive muscle tone and contraction [2]. Spasticity usually hinders rehabilitation process in patients after stroke [3] with higher health care cost [4]. Some orally active agents such as baclofen is commonly used for the management of spasticity, however, drug-induced adverse effects like muscle weakness and hepatotoxicity remains problematic [5].…”

Early AbobotulinumtoxinA (Dysport®) in Post-Stroke Adult Upper Limb Spasticity: ONTIME Pilot Study

“…While the ONTIME study suggests early abobotulinumtoxinA injection delays symptomatic spasticity development, the effects may not be restorative to maladaptive changes in the brain, due to the finite duration of treatment effect. However, early treatment may modify disease progression before secondary local biomechanical changes occur [ 22 , 23 , 24 ]. Disease modification at the level of cortical reorganization was demonstrated through functional magnetic resonance imaging in BoNT-A therapy for chronic PSS [ 25 ], suggesting preventive potential—and a possible paradigm shift towards early intervention.…”

The effect of aquatic and treadmill exercise in individuals with chronic stroke

“…Therefore, the buoyancy effect might be a specific factor that underestimates gait training. Unfortunately, muscle strength does not increase enough under standard physical therapy sessions for stroke in order to perform other daily life activities 27 .…”