sever spastic patient

[saeidphysio]

Hi,

I have a old man (Patient) with sever spastic pattern in all body (extension spasm in left side & flex. spasm in right side). Is there any physio help with how to deal with him? thanks

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[physiobob]

Hi,

I have a old man (Patient) with sever spastic pattern in all body (extension spasm in left side & flex. spasm in right side). Is there any physio help with how to deal with him? thanks

I agree that we need to know a little more about his main issues? Is he post stroke? post head injury? In general maybe take a Bobath approach to assessment. This would include things like looking at the effect of his spasticity in sitting (compared to standing or walking). When in sitting vary the amount of support to his pelvis and trunk to see if thie affects the tone in the effected limbs. e.g. maybe his sitting reduces his stasticity compared with standing or walking. If this is so then you have a starting point i.e. improve sitting balance first - reaching from sitting, perhaps sitting on a gymball with varying amounts of support. You can be pretty creative to see what reduces and what increases the tone. In this way you can see what is compensatory strategy or 'reflexive' tonal increases and what is more under higher control.

Please keep us informed and let us know you results so we can all provide more strategies. This might even include things such as botox...

[vasanth]

There are numerous methods to reduce spasticity.
But which PT Technique works?
Unfortunately other than functional exercises, the other inhibitory techniques carry poor evidence in support of improvement.
A patient with stroke eventhough presenting with spasticity is affected by numerous other impairments. Hence a stroke patient should not be viewed as only spastic . Muscle strength is one such impairment that has been said to occur in most stroke patients. But because of the heavy influence of Bobath technique our mind set has not changed away from that of spasticity. Hence if the goal of therapy is targeted towards more functional activities can benefit the patient.

[ikreuzer]

Hi Saeidphysio,

you ask specifically how to deal with your "old patient...", can you give us more information, please.
What is your goal, are you trying to make him comfortable, are you hoping for improvement of function. is he bed-bound, ambulating, what is his mental status, is he at home, and how old is he?
Also, please elaborate on the spasticities, what are the pathologies that produced this very unusual picture, what are we dealing with here? Whjere exactly is the spasticity, which muscles are effected, any contractures, how longstanding is this condition, any clonus, tremors, rigidities, etc?
I am really intrigued by this picture, and would really like to know more.
IK