Transcript Oral Medications

How will you grade the spasticity
of the patient?
• Spasticity or muscular hypertonicity is a
- disorder of the central nervous system (CNS) in
which certain muscles continually receive a message to
tighten and contract.
-The nerves leading to those muscles, unable to
regulate themselves (which would provide for normal
muscle tone), permanently and continually "over-fire"
these commands to tighten and contract.
- This causes stiffness or tightness of the muscles
and interferes with gait and movement, and
sometimes speech.
Modified Ashworth Scale
0
1
No increase in muscle tone
Slight increase in muscle tone, manifested by a catch
and release or by minimal resistance at the end range
of motion when the part is moved in flexion or
extension/abduction or adduction, etc.
1+
Slight increase in muscle tone, manifested by a catch,
followed by minimal resistance throughout the
remainder (less
than half) of the ROM
marked increase in muscle tone through most of the
ROM, but the affected part is easily moved
Considerable increase in muscle tone, passive
movement is difficult
Affected part is rigid in flexion or extension
(abduction or adduction, etc.)
2
3
4
Goals of spasticity management
• To improve function related to the activities of
daily living, mobility, the ease of care by
caregivers, sleep, cosmesis, and overall functional
independence
• To prevent orthopedic deformity, the
development of pressure areas, and the need for
corrective surgery
• To reduce pain
• To allow the stretching of shortened muscles, the
strengthening of antagonistic muscles, and the
appropriate orthotic fit
treatment options
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Physical and occupational therapy
Speech and language therapy
Orthoses
Casting
Botulinum toxin or phenol injections
Intrathecal baclofen pump implantation
Orthopaedic surgery
SDR surgery
Oral medications
Physical, Occupational and Speech
Therapy
• Physical and occupational therapy are the mainstays of treating
children with cerebral palsy and other brain injuries.
• Therapists provide range-of-motion exercises to prevent
contractures. The exercises include moving joints to maintain or
improve flexibility, stretching to maintain muscle length,
strengthening, and performing functional movements.
• Therapy also helps maximize the impact of other treatments.
• Speech/language pathologists assess speech and swallowing
problems and work with patients to improve their language
and other skills.
Orthoses
• Orthoses can help to compensate for
weakness and instability.
• Although they typically don’t reduce
spasticity, they may help prevent
complications of spasticity (such as
contractures) or abnormal joint positions.
• Ankle-foot orthoses have been known to
decrease clonus at the ankle as measured by a
computerized gait analysis.
Botulinum Toxin and Phenol
Injections
• Neurolytic blocks (using botulinum toxin or
phenol) can
focally reduce hypertonicity. The blocks can be
used in
children of any age.
• The blocks often control spasticity and its
complications until more aggressive treatments
are appropriate.
• The blocks can be used indefinitely if continued
functional improvements are seen.
Oral Medications
• Oral medications are a systemic, rather than
focal, treatment for spasticity in children.
• Oral medications commonly used in children
are baclofen, diazepam, dantrolene and
tizanidine.
Surgery
• Intrathecal Baclofen Pump Implantation
– baclofen is delivered intrathecally by a catheter
attached to a subcutaneously implanted
computerized pump (spasticity can be markedly
reduced)
– The pump needs refilling every one to three
months and replacing when the battery loses
power (usually after five to seven years)
Orthopaedic Surgery
• used to help correct the secondary problems
that occur with growth in the face of spastic
muscles and poor motion control.
• Those problems include muscle contractures
and bony deformities.
SDR Surgery
• reduces spasticity, primarily in the trunk and legs.
• Surgeons identify dorsal or sensory roots at the L1 to
S1 or S2 levels, then divide them into rootlets.
• The rootlets are then stimulated, and the resulting
motor or reflex responses are monitored by
electromyography and on clinical exam.
• If an abnormal response is seen, the rootlet is cut. The
percentage of rootlets cut varies among patients,
depending on their response to stimulation, but
typically it’s between 25 and 45 percent.