Management of Spasticity

Katz, Richard T.

doi:10.1097/00002060-198806000-00004

Cited by 114 publications

(25 citation statements)

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“…Clinicians such as Schiess et al (9), however, have used the flex dosing to improve spasticity control in the upper extremities and in their stroke population. The mechanism of the flex dosing or bolus is not completely understood, but it is thought that a bolus of ITB better reaches the upper spinal canal and, thus, the upper extremities.…”

Section: Discussionmentioning

confidence: 99%

“…Cortical spasticity usually manifests as dystonic posturing and hemiplegia (9); spinal spasticity typically involves spasticity found in the antigravity muscles, that is, flexor muscles in the arms and extensor muscles in the legs (9)(10)(11). Cortical spasticity applies to lesions within the brain; spinal spasticity is indicative of spinal pathology.…”

Section: Introductionmentioning

confidence: 99%

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Intrathecal Baclofen for Spasticity Management: A Comparative Analysis of Spasticity of Spinal vs Cortical Origin

Saval

Chiodo

2010

The Journal of Spinal Cord Medicine

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Background/Objective: To examine the differences in intrathecal baclofen management of individuals with spasticity of cortical vs spinal etiologies. Design: Retrospective chart review of 57 individuals with the diagnoses of severe cortical and spinal spasticity requiring an intrathecal baclofen pump. Methods: Parameters evaluated included daily dosage of medication required, flex vs simple continuous delivery modes, dosing changes, need for other local spasticity treatment, and catheter complications. Results: There were no statistically significant differences between individuals with cortical spasticity and spinal spasticity when comparing daily dosage, number of contacts, and mode of delivery. At 6 months, there was a statistically significant difference in dosing between individuals with multiple sclerosis and those without. Within groups, there was a significant difference in average daily dosing over 3 years. A significant difference was found comparing the use of botulinum toxin type A for upper extremity spasticity within the cortical group. Nine individuals had catheter complications. Conclusions: Cortical and spinal spasticity appear to parallel each other with no significant differences in daily dosing, dosing changes, and mode of delivery of intrathecal baclofen. This did not hold true at all time points for the multiple sclerosis subgroup. The significant difference noted within groups for daily dosing over the first 3 years challenges the notion of stable dosing over time. Focal injections of Botox/phenol in the upper extremities are an important adjunct therapy for patients with cortical spasticity, even after the placement of an intrathecal baclofen pump. Our complication rate was slightly lower than that reported in the literature.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intrathecal Baclofen for Spasticity Management: A Comparative Analysis of Spasticity of Spinal vs Cortical Origin

Saval

Chiodo

2010

The Journal of Spinal Cord Medicine

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“…25 Hepatoxicity is a serious issue with long-term use of dantrolene in 1% of cases, and adverse effects include excessive weakness and gastrointestinal distress. 26 The ␣ 2 -agonist tizanidine hydrochloride may induce less reduction in strength than baclofen and diazepam but may cause more sedation. 27 Dry mouth and hypotension also may occur with tizanidine.…”

Section: Ongoing Care In the Medical Homementioning

confidence: 99%

“…26 The latter are useful for the treatment of focal spasticity in a specific muscle group. 28 A single set of injections will produce clinical results in 1 to 3 days, peak after 4 weeks, and provide benefit for 3 or 4 months with rare adverse effects.…”

Section: Ongoing Care In the Medical Homementioning

confidence: 99%

Providing a Primary Care Medical Home for Children and Youth With Cerebral Palsy

Cooley¹

2004

Pediatrics

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ABSTRACT. Children and youth with cerebral palsy present pediatricians with complex diagnostic and therapeutic challenges. In most instances, care also requires communication and comanagement with pediatric subspecialists and pediatric surgical specialists, therapists, and community developmental and educational teams. The importance of family resilience to the patient's wellbeing broadens the ecologic scope of care, which highlights the value of a primary care medical home from which care is initiated, coordinated, and monitored and with which families can form a reliable alliance for information, support, and advocacy from the time of diagnosis through the transition to adulthood. This report reviews the aspects of care specific to cerebral palsy that a medical home should provide beyond the routine health maintenance, preventive care, and anticipatory guidance needed by all children. Pediatrics 2004;114:1106-1113; cerebral palsy, developmental disability, medical home, chronic illness, spasticity.

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“…2 Local application of cold is used clinically to diminish the resistance of spastic muscle to rapid stretching and to decrease or abolish clonus. 3 Cold can be applied to the body in three dierent ways: immersing in cold water, rubbing with ice cubes or ice packs or using evaporative sprays such as ethyl chloride. Immersing part of body in cold water is limited because it is dicult to apply to large area of the body.…”

Section: Introductionmentioning

confidence: 99%

Effect of cold air therapy in relieving spasticity: applied to spinalized rabbits

2002

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Study design: Before-After trial measured prior to cold air therapy, immediately following, after 30 and 60 min. Objective: To determine the eect of cold air therapy in relieving spasticity, the optimal intramuscular temperature, and the duration of spasticity relief attained by cold air therapy. Setting: Clinical research laboratory, Seoul, Korea. Subject: Forty-six spastic paraplegic rabbits with spinal cord injury. Methods: Spastic paraplegia was induced by transection of spinal cord in 46 rabbits. Cold air was applied to triceps surae muscles for 30 min at three dierent intramuscular temperatures (25, 30 and 32.58C). Clinical parameters of spasticity (muscle tone, Babinski's sign, muscle stretch re¯ex and ankle clonus) and electrophysiologic parameters (F/M ratio and H/M ratio) were measured immediately following, after 30 and 60 min. Results: In the 32.58C group, relief in spasticity lasted less than 30 min. In the 30 and 258C groups, the decrease in spasticity lasted for at least 30 min clinically. The spasticity relief was observed only immediately following treatment when measured electrophysiologically. However, six out of 16 cases (37.5%) in the 258C group showed complete motor conduction block. Conclusion: To relieve spasticity with cold air therapy, the intramuscular temperature should be maintained at 308C. The duration of spasticity relief lasted from between 30 ± 60 min after cold air therapy.We certify that all applicable institutional and governmental regulations concerning the ethical use of animals were followed during the course of this research.

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Management of Spasticity

Cited by 114 publications

References 0 publications

Intrathecal Baclofen for Spasticity Management: A Comparative Analysis of Spasticity of Spinal vs Cortical Origin

Intrathecal Baclofen for Spasticity Management: A Comparative Analysis of Spasticity of Spinal vs Cortical Origin

Providing a Primary Care Medical Home for Children and Youth With Cerebral Palsy

Effect of cold air therapy in relieving spasticity: applied to spinalized rabbits

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