Understanding of spasticity: implications for practice
Spasticity is a poorly understood phenomenon, both by medical professionals as by patients. The aim of this paper is to comprehend the effect of spasticity on daily life and identify bedside strategies that enhance patient’s function and improve comfort.
Patients with MS, stroke, traumatic brain injury and spinal cord injury experiencing spasticity were asked to complete a semi-structured interview to explain and describe the nature of their experienced spasticity on daily basis.
Key points: Spasticity affects activities of daily living, function, and mobility. Pain, discomfort, stress and fatigue are enhancing spasms, as are comorbidities such as UTI’s. and kidney stones. Undertreated spasticity can lead to pain, immobility, and risk of falls.
Helpful strategies were identified: a holistic approach to medication by doctors, daily and thorough stretching, comfort strategies such as warm water and quiet environments, and use of alternative medicine like meditation and acupuncture for mood control.
Spasticity and clonus result from an upper motor neuron lesion that disinhibits the tendon stretch reflex; however, they are differentiated in the fact that spasticity results in a velocity dependent tightness of muscle whereas clonus results in uncontrollable jerks of the muscle. An overview of pathophysiology of UMN and LMN lesions, and the importance of sensory input for muscle tone is provided.
Then patient experiences were recorded to identify missed opportunities for care and develop helpful bedside strategies.
Spasticity affects activities of daily living, function, and mobility. Undertreated spasticity can lead to pain, immobility, and risk of falls.
Missed opportunities to adequately care for patients with spasticity were: not enough time allocated for ADL, not enough understanding of the effect of spasticity on mobility, not enough stretching and too much medical jargon used by care givers.
Helpful bedside care strategies were outlined: use of alternative therapies in conjunction with medications are needed to better manage spasticity, daily (self) stretching is the corner stone of management, and individual comfort strategies to improve relaxation and mood are paramount.
Individualized care and patient reports on spasticity are important and should be part of clinical evaluation and practice.
Any additions to this qualitative research from your own clinical experience with spasticity you want to discuss?
> From: Bhimani et al., Rehabil Res Pract 2014 (2015) 279175. All rights reserved to The Author(s). Click here for the Pubmed summary.