Spasticity Goals and Objectives Course Description “Spasticity” is an online recorded video of a previously presented live CE webinar for physical therapists and physical therapist assistants. This course includes a review of current literature relating to pathophysiology, measurement, pharmacological management, and rehabilitation techniques for spasticity. Course Rationale The purpose of this course is to provide a comparative analysis of traditional and contemporary techniques to assess and manage spasticity based on current research to aid the clinician in employing these techniques effectively to facilitate recovery of motor control. Course Goals and Objectives Upon completion of this course, participants will be able to: 1. Identify the pathophysiology of spasticity. 2. Identify the causes of hemiplegic shoulder pain. 3. Compare scales utilized to assess muscle tone. 4. Define the role of casting and splinting aid in contracture management. 5. Identify the stages of recovery of motor control. 6. Differentiate current treatment concepts specific to managing spasticity. 7. Select therapeutic interventions to manage increased muscle tone and facilitate motor control. 8. Identify the effectiveness of electrical stimulation for spasticity reduction. 9. Define how constraint induced movement therapy and vibration impact muscle tone. 10. Classify various methods pharmacological management of spasticity. Course Provider – Innovative Educational Services Course Instructor - Jodi Gootkin, PT, MEd, CEAS Target Audience – Physical Therapists, Physical Therapist Assistants Course Educational Level – This course is applicable for introductory/intermediate learners. Course Prerequisites – None Method of Instruction/Availability – Recorded video available on demand at cheapceus.com. Criteria for Issuance of CE Credits – Completion of viewing of 3 hour recorded video, and a score of 70% correct or greater on the course post-test Continuing Education Credits – Three (3) hours of continuing education credit. Course Fee - $34.95 Conflict of Interest – No conflict of interest exists for the presenter or provider of this course. Refund Policy - Unrestricted 100% refund upon request. The request for a refund by the learner shall be honored in full without penalty or other consideration of any kind. The request for a refund may be made by the learner at any time without limitations before, during, or after course participation. Innovative Educational Services Course Overview 2 “Spasticity” examines traditional and contemporary interventions used to normalize muscle tone. This course includes a review of current literature 1 relating to pathophysiology, measurement, SPASTICITY pharmacological management, and rehabilitation techniques for spasticity. Live Interactive Webinar Presented By: Jodi Gootkin, PT, MEd, CEAS [email protected] Copyright J. Gootkin 2019 Copyright J. Gootkin 2019 Course Rationale 3 Goals and Objectives 4 The purpose of this course is to provide a 1. Understand the pathophysiology of spasticity. comparative analysis of traditional and 2. Compare scales utilized to assess muscle tone. 3. Identify how the developmental sequence is utilized to facilitate return contemporary techniques to assess and manage to function. spasticity based on current research to aid the 4. Differentiate current treatment concepts specific to managing spasticity. 5. Select therapeutic interventions to manage increased muscle tone and clinician in employing these techniques effectively facilitate motor control. to facilitate recovery of motor control. 6. Determine the effectiveness of electrical stimulation for spasticity reduction. 7. Summarize how mirror therapy and vibration impact muscle tone. 8. Define the role of contracture management in reducing spasticity. 9. Classify various methods pharmacological management of spasticity. 10. Identify surgical management techniques for spasticity. Copyright J. Gootkin 2019 Copyright J. Gootkin 2019 Topic Time Normal vs. Abnormal Muscle Tone 0:00-0:05 Pathophysiology of Spasticity 0:06-0:15 Spasticity Assessment 0:16-0:20 Disclaimer 5 Modified Ashworth Scale 0:21-0:256 Course Modified Tardieu Scale 0:26-0:30 Outline Rehabilitation Interventions 0:31-0:35 Application of concepts presented in this webinar is Developmental Sequence 0:36-0:50 and Interactive Discussion of Clinical Applications 0:51-0:60 at the discretion of the individual participant in Schedule Brunnstrom Techniques 1:00-1:15 accordance with federal, state, and professional Bobath Techniques 1:16-1:35 regulations. Proprioceptive Neuromuscular Facilitation 1:36-1:50 3-hour live Interactive Discussion of Clinical Applications 1:51-2:00 Complementary Interventions 2:01-2:05 interactive Electrical Stimulation 2:06 -2:10 webinar Mirror Therapy and Vibration Treatment 2:11-2:15 Contracture Management 2:16-2:25 Pharmacological Management 2:26-2:30 Consider Intrathecal Baclofen 2:31-2:35 This Botulinum Toxin A 2:35-2:40 Surgical Management 2:41-2:50 Interactive Discussion of Clinical Applications 2:51-3:00 Copyright J. Gootkin 2019 Copyright J. Gootkin 2019 Spasticity Copyright 2019 (c) Innovative Educational Services and Jodi Gootkin. All rights reserved. Reproduction, reuse, or republication of all or Copyright Jodi Gootkin 2019 any part of this presentation is strictly prohibited without prior 1 written consent of both Innovative Educational Services and Jodi Gootkin. How To Obtain CEUs For This Course 7 Normal Muscle Tone 8 • After the live interactive webinar and prior to • At rest there is a minimal amount of tension 11:59 pm TONIGHT go to www.cheapceus.com maintained in a muscle that resists passive • Complete the post test with score of at least stretch. 70% • Resting tone is low enough to allow movement • May be retaken multiple times but high enough to support activity. • Submit online payment for course • Print certificate • Course review and summary for post test at the Consider end of the webinar. This Copyright J. Gootkin 2019 Copyright J. Gootkin 2019 Muscle Spasm 9 Tone Alterations 10 Spasticity • In an intact neuromuscular system, involuntary contraction of a muscle due to overuse, electrolyte • Resting tone in imbalance, or dehydration. the muscle changes in Hypertonia Rigidity • Often presents in therapy as the body’s protective response to mechanism to avoid further injury or in response to injury of the muscular compensations for movement. Decorticate and nervous system. Decerebrate Rigidity Muscle Spasm = Spasticity Hypotonia Flaccidity Copyright J. Gootkin 2019 Copyright J. Gootkin 2019 Spasticity Definition 11 Nervous System 12 “A disorder of the sensorimotor system • The nervous system is subdivided into two characterized by a velocity-dependent increase primary components: in tonic stretch reflexes (muscle tone) with • Central Nervous System (CNS)– brain and exaggerated tendon jerks, resulting from spinal cord hyperexcitability of the stretch reflex.” • Peripheral Nervous System (PNS)– sensory and motor nerves outside of CNS Lance J. W. (1980). “Symposium,” in Spasticity: Disordered Motor Control, eds Feldman R. G., Young R. R., Koella W. P., editors. (Chicago: Year Book Medical Pubs; ), 485–495 Consider This Copyright J. Gootkin 2019 Copyright J. Gootkin 2019 Spasticity Copyright 2019 (c) Innovative Educational Services and Jodi Gootkin. All rights reserved. Reproduction, reuse, or republication of all or Copyright Jodi Gootkin 2019 any part of this presentation is strictly prohibited without prior 2 written consent of both Innovative Educational Services and Jodi Gootkin. Healthy Stretch Reflex 13 Lower Motor Neuron Lesion 14 •Normally when muscle is • The healthy stretch elongated, the muscle spindle recognize the reflex response is altered length and speed at absent with a lower which it occurred. motor neuron •When stretched quickly, it lesion of the transmits a signal to the peripheral nerve spinal cord triggering the stretch reflex. resulting in • Signal sent back down motor flaccidity and neuron to muscle which hyporeflexia. develops tension to resist the change in length. Copyright J. Gootkin 2019 Copyright J. Gootkin 2019 Upper Motor Neuron Diagnoses Syndrome 15 16 • Injury or disease process • Conditions presenting with spasticity involve of the brain or spinal cord upper motor neuron lesions. presents with specific • Cerebral Palsy CP signs/symptoms. • Multiple Sclerosis MS • Spasticity • Traumatic Brain Injury TBI •Hyperreflexia •Spinal Cord Injury SCI • Associated Reactions • Cerebrovascular Accident CVA • Motor Weakness • Amyotrophic Lateral Sclerosis ALS • Parkinson's Disease PD Copyright J. Gootkin 2019 Copyright J. Gootkin 2019 Disrupted Descending Pathophysiology of Spasticity 17 18 Regulation • Several mechanical and neuronal mechanisms • Upper motor neuron lesions result in an have been theorized as result in prolonged imbalance of excitatory and inhibitory disinhibition of the spinal reflexes that result in spinal tracts between the brain and spasticity. muscles. • Disrupted descending regulation • This leads to reduced inhibitory control • Denervation supersensitivity over the stretch reflex that allows exaggerated muscle firing at rest. • Hyperexcitable stretch reflex Excitation Consider Inhibition This Copyright J. Gootkin 2019 Copyright J. Gootkin 2019 Bartolomeo Eustachi: Brain and Spine Anatomy, c. 1722 Bartolomeo Eustachi (1520?-1574): Tabulae anatomicae clarissimi viri, 1722. Spasticity Copyright 2019 (c) Innovative Educational Services and Jodi Gootkin. All rights reserved. Reproduction,