Spasticity

Question 1

Result from the release of intact ____ _____ in the CNS, unable to providing ____ and _____ below level of injury

Answer 1

• Reflex Arcs
• Control
• Inhibition

Question 2

Characteristics of Spasticity

Answer 2

• Hyperonicity
• Hyperactive Stretch Reflexes (DTR)
• Clonus
• • Babinski
• Typically occurs below the level of the lesion after spinal shock subsides
• Gradually increases fro approximately 6 months
• Usually plateaus within 1 year post injury

Question 3

Factors that contribute to Spasticity

Answer 3

• Positioning
• Cutaneous Stimulation
• Environmental Temperatures
• Tight clothing
• Bladder or Kidney Stones
• Fecal Impactions
• Catheter Blockage
• UTI
• Decubitus Ulcers
• Emotional Stress

Question 4

Management if spasticity interferes with funtion

Answer 4

• Inhibition techniques
• Oral Med’s
• Intrathecal Baclofen Pump
• Individual Nerve blocks with phenol injections
• Botulinum Toxin
• Surgical Approaches
• BladderDysfunction

Question 5

Oral Medications

Answer 5

• mm relaxants and anti-spasmodic agents
• Valium
• Lioresal
• Dantrium
• Catapres
• Not always successful so must weigh side effects verse improved function

Question 6

Valium

Answer 6

• Diazepam

Question 7

Lioresal

Answer 7

• Baclofen

Question 8

Dantrium

Answer 8

• Dantrolene Sodium

Question 9

Catapres

Answer 9

• Clonidine

Question 10

Intrathecal Baclofen Pump

Answer 10

• More effective for LE Spasticity than UE
• Baclofen is delivered directly into the spinal canal, which allows for a lower dosage
• More permanent abatement of spasticity

Question 11

Individual nerve blocks with phenol injections can provide?

Answer 11

• 3 to 6 months relief

Question 12

Botulinum Toxin

Answer 12

• A botox can be injected directly into mm causing temporary local paralysis

Question 13

Surgical Approaches

Answer 13

• Myotomy
• Neurectomy
• Tentomy
• Rhizotomy
• Myelotomy

Question 14

Myotomy

Answer 14

• Sectioning or release of a mm

Question 15

Neurctomy

Answer 15

• A partial or complete severance of a nerve

Question 16

Tenotomy

Answer 16

• A sectioning of a tendon which allows subsequent lengthening
  ie: Heel Cords
• Decrease spasticity by altering the contraction potential of the mm

Question 17

Rhizotomy

Answer 17

• Severance of nerve roots

Question 18

Myelotomy

Answer 18

• Severance of spinal cord nerve fibers

- More radical and only used in extreme cases