I see nothing out there that in the 11 years since that any protocol exists for spasticity. You can read the 6 pages on your own. And what is even worse is this is management of spasticity NOT curing spasticity. The tyranny of low expectations in full display. YOU get to be the recipient of such incompetence.
Chemodenervation and Nerve Blocks in the Diagnosis and Management of Spasticity and Muscle Overactivity
2009, PM&R
Elie P. Elovic, MD,
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 2 decades, 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, severity, 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 hierarchical approach has been supplantd 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 presentations 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 hemipares is 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. (Fuck you and your tyranny of low expectations! When you have a stroke will you be ok with this crapola?)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.(Meaningless)
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 2 decades, 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, severity, 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 hierarchical approach has been supplantd 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 presentations 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 hemipares is 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. (Fuck you and your tyranny of low expectations! When you have a stroke will you be ok with this crapola?)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.(Meaningless)
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