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Query: UMLS:C0026838 (spasticity)
 6,471 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A review was made of 88 adult institutionalized patients with spastic cerebral palsy and contractural deformity of the hips. 21 were untreated for dislocated hip, and 11 of these suffered from hip pain. The degree of pain was directly related to neurological maturity and to the coexistence of athetosis and spasticity. Decubitus ulcers and perineal care problems were more associated with contractures than with dislocation alone. It is concluded that dislocation and subluxation should be prevented by surgical means, but that surgical treatment of the already dislocated hip should be reserved for the neurologically mature and athetoid patient.
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PMID:Natural history of the dislocated hip in spastic cerebral palsy. 52 Jul 12

The use of F.E.S. in motor rehabilitation should be reserved for cases of central neurological lesions. F.E.S. tends to improve gait, reduce spasticity and improve the transfer of cortical information from the peripheral system. The treatment exploits the possibilities of reprogramming movement by developing new motor circuits and where possible restoring lost movements.
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PMID:[Functional electric stimulation. Our experience]. 660 42

Spasticity, a common symptom of upper motor neuron lesions, may actually aid the patient and should be treated only if it interferes with function, comfort or nursing care. Stretching exercises and elimination of nociceptive stimuli are the first steps in management. If problems persist, medication should be considered. Tenotomies are useful. Motor-point blocks and peripheral nerve blocks are temporary aids, while neurectomies usually provide permanent relief. More drastic neurosurgical procedures are reserved for uncontrolled, incapacitating cases.
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PMID:Managing spasticity. 711 81

The orthopedic management of spasticity is based on the effects of this neurologic condition on the bones and tissues of the growing child. The goal of such intervention is to maximize function, reduce disability, and facilitate mobility. Goal-directed treatment plans are tailored for each patient and may include a combination of modalities such as physical and occupational therapy, casting, orthoses, and surgery. Physical and occupational therapy is emphasized up to 4 to 5 years of age, whereas surgery is best between 5 and 7 years of age. Education and psychosocial development should be emphasized beginning at age 7 years through adulthood, with surgery reserved for more involved cases of contracture or bony dysplasia. In adulthood, treatment should be focused on integration into society and maximizing functional independence. Although there are many undisputed benefits of therapy, no consensus exists regarding the most beneficial modality, the age group that would benefit most, or whether continued treatment is beneficial in adulthood. Whereas the use of serial casting and tone-reducing casts has lessened, lower extremity orthoses have gained widespread acceptance with improvements in design and fabrication and have been demonstrated to help restore normal heel-toe gait. Surgical techniques such as tendon lengthening, transfer, bony osteotomy, and joint fusion are time-honored techniques that continue to be refined with current advances in the use of computerized gait analysis for preoperative planning. Further research in long-term results and outcomes measurement will be necessary to fully assess the impact of current treatment.
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PMID:Spasticity: orthopedic perspective. 1122 56

Botulinum toxin has been used in urology since the end of the 1980s. However, this therapeutic option has not been firmly established yet. Valid studies have merely been conducted on detrusor sphincter dyssynergia (DSD) and on detrusor overactivity (hyperreflexia), but even those findings do not allow final conclusions. Success rates in DSD are between 58% and 88%, in detrusor overactivity approximately 80%. Further possible indications for botulinum toxin are motor and sensory urge, urethrospasm, spasticity of the pelvic floor, neobladder, and even chronic prostatic pain. To reach firmer conclusions, controlled studies with well-defined patient populations and using validated and reproducible outcome measures are needed. In addition, we also need information on repeated injections over a long period of time. These data are not available to date. At present, the application of botulinum toxin should be reserved for experienced users only.
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PMID:Botulinum toxin in neuro-urological disorders. 1502 67

Treatment of spasticity requires a team approach, including the patient and caregivers, therapists, physicians, and surgeons. The team needs to determine what component of the spasticity interferes with function. Traditional therapy continues to dominate the therapy provided to patients who are living with spasticity. Treatment of increased tone must be part of the overall treatment plan for the patient. The plan may also include physical and occupational therapy, oral medication, injections of botulinum toxin, use of an intrathecal baclofen pump, or surgery. For patients with limited improvement from therapy, injections of botulinum toxin are often first-line treatment for focal spasticity involving overactive muscle groups. Botulinum toxin is safe when used at recommended doses and has limited side effects. The benefits of oral medications in patients with focal spasticity may be limited by adverse effects at higher doses. Refractory spasticity may be treated with intrathecal baclofen. Surgery is reserved for patients in whom the other modalities fail to provide meaningful improvement. Continued communication from all members of the team can assure the best spasticity management plan for the individual patient, but patients need to have realistic expectations about outcome.
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PMID:Spasticity. 1936 49

Intractable and severe spasticity in childhood has the ability to impact on the quality of life, function and care of the child. Where medical and physical measures have proved insufficient, a surgical approach may be pursued. Irrespective of the underlying pathology, intrathecal baclofen will reduce spasticity in a controllable and reversible fashion, whereas selective dorsal rhizotomy is reserved for the management of bilateral cerebral palsy due to early birth. Owing to the potential for complications of intrathecal baclofen and the permanence of selective dorsal rhizotomy, careful selection and preparation are required to produce satisfactory results.
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PMID:Surgical management of spasticity. 2443

The occurrence of urogenital dysfunction as an isolated early symptom in multiple sclerosis (MS) is rare, but the prevalence thereof becomes high with progression of disease. Lower urinary tract dysfunction may add to the cause of death (particularly through urinary infections), but both urinary and sexual dysfunction significantly affect quality of life of patients. Both storage and evacuation of urine may be affected by MS, and ultimatively the functional diagnosis can only be made by urodynamic testing. As upper urinary tract affection is, however, rare (and can be prevented by timely ultrasound imaging), a first stage diagnostics in the MS center by the neurologist and specialized nurse is appropriate. History, urine tests and post void residual urine determination (preferably by ultrasound) should provide necessary data for treatment of infections, and also symptomatic management of frequency, urgency and incontinence by bladder training, anticholinergics, and intermittent self catheterization (as indicated); the referral to urologist may be reserved for patients who fail first line treatment. Treatment in the late stages of MS is as yet little researched, but eventually a suprapubic catheter is the preferred method of bladder emptying. Sexual dysfunction should be actively sought in MS patients (in men erectile and ejaculation dysfunction, in women deficient lubrication and genital hyper- or hyposensitivity are frequent). Clinical examination contributes little to clarification of neurogenic sexual dysfunction, but defines the extent of other deficits due to MS, which may be relevant for sexual counseling (spasticity, sensory loss). Sildenafil has been demonstrated to be effective in treatment of men, but not in women. Other management options exist, and the doctor and nurse in the MS center should be proactive in providing first line counseling and management.
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PMID:Urogenital dysfunction in patients with multiple sclerosis. 2538 63

Spasticity is a complex pathology, both in terms of assessment and treatment. This article focuses on the clinical examination (objective, capacity, performance and function), which is key for choosing a treatment and can be helped by botulinum toxin injections. The treatment involves physical therapy, occupational therapy, medications and surgery. Neurectomy has been used in the upper limb since 1912 and is one of the therapeutic options for spasticity. This treatment is usually reserved for nonfunctional hands. Cadaver studies have helped us better understand nerve anatomy and improve the hyperselective neurectomy (HSN) technique. This article describes the history of neurectomy, how anatomical dissections apply to surgery, the HSN technique in the musculocutaneous nerve, median nerve and ulnar nerve and results of preliminary prospective studies. Spasticity, mobility, performance and function were evaluated a few months after HSN and about 12 months later to assess the permanence of the results in children and adult spastic patients. No matter the nerve or function targeted (elbow extension, wrist extension, or supination), spasticity was reduced with improvements in the functional House score and appeared stable at the last follow-up. HSN seems to be a good, reliable therapeutic option for spasticity, including functional hands.
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PMID:Spasticity and hyperselective neurectomy in the upper limb. 2903 27