This is absolutely awful, littered with the tyranny of low expectations. I would have them all fired. I guess you could ask your doctor if anything better exists in the 11 years since. Until we get stroke survivors in charge nothing will get better.
Examples of appropriate goals include improved range of motion, reduction of co-contraction, and improved local function.
lessen suffering and prevent secondary complications.
Fuck, HAVE YOU NEVER TALKED TO SURVIVORS? THEY WANT RECOVERY, NOT THIS LAZY CRAPOLA.
If you don't have anything better than this, get the research done that will. THAT is what leadership looks like. Are you leaders or mice?
"Chemodenervation and Nerve Blocks in the Diagnosis and Management of Spasticity and Muscle Overactivity" by Alberto Esquenazi
2009, PM&R
Elie P. Elovic, MD, Alberto Esquenazi, MD, Katharine E. Alter, MD, John L. Lin, MD,Abraham Alfaro, PhD, DO, Darryl L. Kaelin, MD
This article will discuss many of the key concepts regarding chemodenervation and neurolysis in the management of spasticity. Topics that will be discussed include techniques for localization, strengths and limitations of various agents (botulinum toxin, phenol, and alcohol), the value of combination therapies, and the role of nerve blocks (diagnostic and therapeutic). With advancing technology have come newer methods to improve accuracy of localization for the performance of chemodenervation and neurolysis such as electro myographic guidance, electrical stimulation, and ultrasound guidance. During the last 2decades, the addition of botulinum toxin chemodenervation as an adjunct to traditional neurolysis, medication, and therapy modalities has expanded the field of treatment of intramuscular hyperactivity in upper motor neuron syndrome. The technique of diagnostic blocks as predictors of response and the therapeutic value of nerve blocks will be discussed.
INTRODUCTION
Numerous factors must be taken into account when deciding on the treatment approach for an individual with spasticity. Etiology, chronicity, prognosis, distribution, location, sever-ity, and medical comorbidities are all important factors. In addition, clinicians must take into account the patient’s and caregiver’s goals to effectively plan a course of action that is realistic, meaningful, and maximizes the potential for success. The classic model of delivering spasticity treatment using a linear, hierarchal approach has been supplanted by a more modern approach of choosing singular or multiple interventions that are based on the factors previously listed.Spasticity and the upper motor neuron syndrome (UMNS) differ greatly in their presen-tations and response. A critical factor in the treatment algorithm is the distribution of the spasticity. It can be focal, affecting a single joint or functional group of joints such as the hand; more widespread, affecting most of a limb; or multisegmental as in spastic hemiparesis when it affects many areas simultaneously. Because chemodenervation affects a limited area, it is important to have realistic outcome expectations. Examples of appropriate goals include improved range of motion, reduction of co-contraction, and improved local function. As the severity of spasticity increases, there is greater emphasis on aggressive management so as to lessen suffering and prevent secondary complications such as contracture and skin breakdown. Diagnostic nerve blocks are minimal risk procedures that may be helpful in determining the presence of contractures and the risk of excessive weakness, as well as estimating potential functional gains after chemodenervation. Often these individuals have other medical conditions that affect decision making, such as altered cognition,diabetes,venous thrombosis, and anticoagulation.When dealing with spasticity in complex neurologic patients, physicians should be holistic in their approach.
Elie P. Elovic, MD, Alberto Esquenazi, MD, Katharine E. Alter, MD, John L. Lin, MD,Abraham Alfaro, PhD, DO, Darryl L. Kaelin, MD
This article will discuss many of the key concepts regarding chemodenervation and neurolysis in the management of spasticity. Topics that will be discussed include techniques for localization, strengths and limitations of various agents (botulinum toxin, phenol, and alcohol), the value of combination therapies, and the role of nerve blocks (diagnostic and therapeutic). With advancing technology have come newer methods to improve accuracy of localization for the performance of chemodenervation and neurolysis such as electro myographic guidance, electrical stimulation, and ultrasound guidance. During the last 2decades, the addition of botulinum toxin chemodenervation as an adjunct to traditional neurolysis, medication, and therapy modalities has expanded the field of treatment of intramuscular hyperactivity in upper motor neuron syndrome. The technique of diagnostic blocks as predictors of response and the therapeutic value of nerve blocks will be discussed.
INTRODUCTION
Numerous factors must be taken into account when deciding on the treatment approach for an individual with spasticity. Etiology, chronicity, prognosis, distribution, location, sever-ity, and medical comorbidities are all important factors. In addition, clinicians must take into account the patient’s and caregiver’s goals to effectively plan a course of action that is realistic, meaningful, and maximizes the potential for success. The classic model of delivering spasticity treatment using a linear, hierarchal approach has been supplanted by a more modern approach of choosing singular or multiple interventions that are based on the factors previously listed.Spasticity and the upper motor neuron syndrome (UMNS) differ greatly in their presen-tations and response. A critical factor in the treatment algorithm is the distribution of the spasticity. It can be focal, affecting a single joint or functional group of joints such as the hand; more widespread, affecting most of a limb; or multisegmental as in spastic hemiparesis when it affects many areas simultaneously. Because chemodenervation affects a limited area, it is important to have realistic outcome expectations. Examples of appropriate goals include improved range of motion, reduction of co-contraction, and improved local function. As the severity of spasticity increases, there is greater emphasis on aggressive management so as to lessen suffering and prevent secondary complications such as contracture and skin breakdown. Diagnostic nerve blocks are minimal risk procedures that may be helpful in determining the presence of contractures and the risk of excessive weakness, as well as estimating potential functional gains after chemodenervation. Often these individuals have other medical conditions that affect decision making, such as altered cognition,diabetes,venous thrombosis, and anticoagulation.When dealing with spasticity in complex neurologic patients, physicians should be holistic in their approach.
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