Physical Medicine & Rehabilitation

Biography

Biography: Areerat Suputtitada

Abstract

Spasticity is a common problem and quite a major challenge to the neurorehabilitation team. It manifests as an increase in stretch reflexes, producing tendon jerks and resistance appearing as muscle tone. Effects of spasticity range from mild muscle stiffness to severe, painful muscle contractures and repetitive spasms that can prevent or hamper function, cause pain, disturb sleep, and major difficulties for hygiene care. However, spasticity can also be useful, perhaps allowing a person to stand or walk when weakness would not otherwise permit it. It is imperative that management is always patient and function focused rather that aimed at the reduction of spasticity only.Of the course of more than 30 years, the novel therapeutic spectrum of botulinum toxin type A (BTA) has been successively expanding worldwide. Optimizing of BTAtreatment is challenging. The trick in practical management is to use it intelligently and to know when and when not to use it. BTA is better tolerated than neurolysis with phenol or alcohol. It is a relatively safe medication and has few serious side effects but its high cost limits the use. Both BTA and phenol or alcohol have dose ceiling limitation. Neurolysis should be preserved for pure motor innervations muscles to avoid paresthesia. BTA is recommended in the distal muscles which are mixed nerves innervations. The proper use of these treatments requires careful patient assessment and realistic goals, knowledge of the peripheral functional anatomy, and an understanding of how these treatments work and how to bestto administer them. Several techniques, usingelectromyography, electrical stimulation, ultrasound guidance are aimed to increase the accuracy of targeting. Neurorehabilitation after BTA injection and neurolysis also enhance treatment outcomes. Basic and sophisticated instrumental balance and gait training, therapeutic exercises, functional electrical stimulation are also important to increase functional outcome. Extracorporeal shock wave therapy (ESWT) are increasing evidences supported. Optimizing BTA, neurolysis and neurorehabilitation in spasticity treatment is importance.