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Chapter-041 Spasticity

BOOK TITLE: Ramamurthy's Decision Making in Pain Management: An Algorithmic Approach

Author
1. M Verduzco-Gutierrez
2. Mas Department of Physical Medicine and Rehabilitation UT Health San Antonio, San Antonio, TX, USA
ISBN
9789386261458
DOI
10.5005/jp/books/14128_42
Edition
3/e
Publishing Year
2018
Pages
3
Author Affiliations
1. University of Texas, Health Science Center, Houston, TX, USA
2. MF
Chapter keywords
Spasticity, modified Ashworth scale, ROM, chemodenervation, cryotherapy, oral antispasmodic agent, gamma-aminobutyric acid, GABA, ITB pump

Abstract

Spasticity is classically defined as an increase in velocity-dependent tonic stretch reflexes. It is a sign of involuntary muscle hyperactivity caused by upper motor neuron injury. Spasticity is commonly utilized as a term for all these signs; however, the clinician must be able to properly evaluate each one and recognize their differences as the treatment can potentially change. A comprehensive history and physical examination is imperative when evaluating for spasticity. Chemodenervation is a commonly used tool in the treatment of focal spasticity. Generally, a substance is injected into the affected muscle or the perineurium of the nerve controlling said muscle or muscle groups. Oral antispasmodic agents can be used to treat generalized spasticity. These can target different pathways that lead to muscle relaxation. Medications can be gamma-aminobutyric acid (GABA) agonists such as baclofen and benzodiazepines. Surgical interventions for spasticity management can target the central nervous system, peripheral nerves or musculoskeletal system. Goals of surgery for spasticity can include: improving function, increasing active movement, pain relief, improved cosmesis and decreased reliance on systemic medications or chemodenervation.

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