WHAT ABSOLUTE FUCKING CRAPOLA! Survivors don't want spasticity assessed or managed; they WANT IT CURED!
You'll want it cured when you are the 1 in 4 per WHO that has a stroke and have spasticity? So will that get you to working on a cure? Or are you willing to roll the dice and live with spasticity like the ridiculous opinion of Dr. William M. Landau?
Spasticity After Stroke: Why Bother? Aug. 2004)
The latest here:
New Expert Guidance on Assessing, Managing Spasticity
A new consensus guideline on the assessment and management(NOT CURE!) of spasticity has been released.
The American Academy of Physical Medicine and Rehabilitation (AAPM&R) guidance includes best practices, evidence-based treatment options, and assessment and management recommendations.
"There is already a lot of literature out there on spasticity, but it tends to be focused on certain groups or specific treatments," co-author Preeti Raghavan, MD, vice chair for research, Department of Physical Medicine and Rehabilitation and Neurology, Johns Hopkins University School of Medicine, Baltimore, told Medscape Medical News.
"This statement brings it all together to provide a comprehensive explanation of spasticity, of what the various conditions are that cause it, the treatments, and a common set of guidelines that individual physicians treating spasticity should know about," said Raghavan(So you're willing to completely fail at curing spasticity? I'd have you all fired!), who is also the director of the Center of Excellence in Stroke Treatment, Recovery, and Rehabilitation, Sheikh Khalifa Stroke Institute, Johns Hopkins University in Baltimore.
The guidelines were published online on May 21 in PM&R.
Consistent Assessments
Spasticity is a motor disorder characterized by increased, involuntary, velocity-dependent muscle tone that causes resistance to movement. The condition can affect gait, movement, and speech and is common in spinal cord or brain injury, cerebral palsy, stroke, and multiple sclerosis.
"Spasticity falls into a huge category from traumatic to nontraumatic causes," Raghavan said.
The guidelines were developed by a technical expert panel convened in 2021 that met virtually over a 16-month period and conducted a structured evidence review. Recommendations were initially reviewed and graded by the AAPM&R Evidence, Quality and Performance Committee, followed by a consensus vote by the panel.
The guideline includes five best practices, beginning with the initial patient evaluation, which should include an assessment of the impact of spasticity on passive and active movement, ability to repeat movements, and function.
Reassessment, which Raghavan called "one of the most salient features" of the new guidance, should occur throughout the treatment course, the panel recommended.
"Spasticity needs to be evaluated before and after treatment in a comprehensive manner, but sometimes people may treat spasticity without evaluating the patient in the same manner across time," Raghavan said.
"You may need to change strategies if the treatment hasn't really been effective for that patient, but you miss the opportunity to evaluate this if you don't use a consistent set of tools each time," he added.
Using standardized measures will improve consistency and allow clinicians to objectively measure responses to interventions. The guideline provides examples of specific measurement tools and what aspect of spasticity each is best at assessing.
"Since there's some debate in the literature about exactly which tools should be used, rather than dictating the specific tool a particular individual clinician should use, we provided guidance by recommending a set of tools," Raghavan said.
Evaluation, treatment, and reassessments should be patient-centered and include the impact on function and quality of life, and not be limited to the reduction of objective measures of tone, the authors noted.
Multimodal Treatments
Spasticity treatment should begin with making sure patients are medically stable and addressing any medical problems that may exacerbate spasticity.
"The first line of treatment for spasticity is rehabilitation therapy, but there is sometimes a situation where spasticity needs to be treated medically first," Raghavan said.
She noted that there's a "growing toolbox of treatments becoming available, both medical and rehabilitative, so providing the right treatment to the right patient is what physical medicine and rehabilitation physicians are well versed in."
Recommendations include the use of oral medications such as baclofen, diazepam, tizanidine, or dantrolene, which can be used exclusively or as a component of a multimodal treatment approach. Botulinum toxin A can be used for the management of focal upper and lower limb spasticity, and phenol or alcohol blocks are recommended for the management of focal spasticity.
Intrathecal baclofen pump therapy for spinal or cerebral origin spasticity in appropriately identified patients and utilization of selective dorsal rhizotomy for patients with spasticity, primarily in the lower extremity, are also advised.
Nonpharmacologic interventions, in conjunction with other therapeutic options, are also an option. These may include different types of stretching, strength and endurance therapy, task training therapy (eg, gait training), electric stimulation, cryotherapy, cryoneurolysis, thermotherapy, dry needling, and acupuncture (including electroacupuncture).
Multimodal therapies are important interventions that should often be used in combination to achieve maximal benefit, the authors wrote.
The guideline deals with the lack of equitable access to care in Black and Hispanic individuals, or children and youth with special healthcare needs, such as those with cerebral palsy.
Factors underlying disparities in spasticity care across the care continuum are multifaceted and require comprehensive and multidisciplinary strategies to counteract, the authors noted. Socioeconomic factors should be considered in spasticity management at the patient and societal levels, they added.
An Important Step
Commenting for Medscape Medical News, Steven Flanagan, MD, professor and chairman of the Department of Rehabilitation Medicine, New York University Grossman School of Medicine, New York City, noted that although spasticity results from a number of neurological conditions, the condition is "inadequately understood by many physicians, which unfortunately leads to insufficient or incorrect management."
"Not surprisingly, spasticity management is unevenly addressed throughout the US and the world," said Flanagan, who also is medical director of the Rusk Institute of Rehabilitation Medicine, NYU Langone Medical Center, New York City, and was not involved with guideline authorship.
This new statement "is an important effort to begin standardizing the management of spasticity, providing evidence-based guidance to physicians treating spasticity as well as valuable information regarding treatment options to those unfamiliar with this condition," he added.
The current consensus statement "is an important step in beginning to standardize spasticity management, based on the specific needs and conditions of people with neurological conditions," Flanagan noted.
The work of the AAPM&R's Spasticity Guidance Technical Expert Panel is supported exclusively by AAPM&R without commercial support. Raghavan received grants unrelated to the current work from the Sheikh Khalifa Stroke Institute, National Institutes of Health, and MedRhythms, Inc. (paid to institution); received patents from New York University; participated on a Data Safety Monitoring Board at Columbia University; and served on the board of the Association of Academic Physiatrists. The other authors' disclosures are listed in the original paper. Flanagan is on the Board of Governors for the AAPM&R but was not involved in the authorship of the paper.
Batya Swift Yasgur, MA, LSW, is a freelance writer with a counseling practice in Teaneck, New Jersey. She is a regular contributor to numerous medical publications, including Medscape Medical News and WebMD, and is the author of several consumer-oriented health books as well as Behind the Burqa: Our Lives in Afghanistan and How We Escaped to Freedom (the memoir of two brave Afghan sisters who told her their story).
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