Measuring spasticity

[oc1dean]

Thanks for the detailed explanation of spasticity, I couldn't find anyone who knew about it. My first PMR doctor knew nothing about spasticity, he wanted to snip the tendons for curled toes rather than knowing about toe crests and metatarsal bumps. none of the therapists knew about spasticity either, but at least I found out that exercise does not increase spasticity. I had to find out about Brunnstroms six stages of recovery myself. I consider myself mildly spastic, but it is an oxymoron that I am not paralyzed enough to easily recover using neuroplasticity.

[gcoe]

You must have found that a discouraging and disappointing experience in your health system. Even though rehab professionals may have differing opinions about the relative importance of spasticity, what is is and how it can be treated, I would have expected a PMR and PT to know something about spasticity and to be acquainted with the area.

It doesn't surprise me that your professionals may not have known much about Signe Brunnstrom’s stages of recovery or her therapeutic methods. At the time (1970's onward) there was a fierce debate about the role of spasticity and how to treat it. Her nemesis, Berta Bobath had a contrary view about spasticity and abnormal reflexes. Basically Bobath believed we should suppress abnormal activity at all costs as it would interfere with recovery while Brunnstrom considered such activity an important step in the recovery of function and that we should use such activity to strengthen the patient. In my part of the world the Bobath Method (in your country often referred to as NDT) dominated the teaching and practice. Because of this "war of views" we weren't exposed to Brunnstrom's ideas which on reflection was a a pity. Of the two Brunnstrom was the greater applied scientist – a real contributor to the observation of normal and abnormal movement at the time. The fact that she emphasised both strengthening and patient lead practice that aimed at skilled movement was ahead of her time. Based on our current knowledge I don’t know if I agree with the staged recovery model however – but that is another story.

Two questions: May I ask what you consider your main problems in terms of what you can’t do now? Would you like me to send you some recent articles on the treatment of spasticity? You may already have them but I have a few new studies stacked away here. If you would like them, however you’ll have to send me an email address – for copyright reasons I can’t post them on public display and the private mail doesn’t have an attachment facility. You can PM me if you want.