Spasticity interferes with life; it affects quality of life and daily activities, including walking, speech, and all types of movement. Spasticity usually occurs as a result of a spinal cord injury or brain injury, either from trauma, stroke or lack of oxygen. It can be caused by metabolic diseases, multiple sclerosis and cerebral palsy and can range from mild to severe stiffness, pain and uncontrollable spasms.

We utilize multiple interventions, customized to each patient's need.

1. Phamachologic management with a variety of FDA approved medications
   
2. Peripheral motor nerve blocks that decrease spasticity and muscle tone via chemoneurolysis
   (Phenol selective motor nerve blocks)
   
3. Botulinum Toxin injections for chemodenervation
   
4. Physical modalities that include physical and occupation therapies.
   Intrathecal Baclofen*
   Surgical correction*
   * Referral to nationally recognized experts

Benefits of Spasticity Management

There are five reasons to treat spasticity.

1. Improve function
2. Improve seating and positioning
3. Improve hygiene
4. Relieve pain
5. Improve patient’s self image.

Achieving Optimum Results

The goal of any spasticity and tone management program should be to achieve optimal results; however, it is essential that each patient’s optimal goal coincides with the physician’s expectations – the patient and caregivers should expect the same results as the treating physician. Using a diagnostic block, a patient can realize expected results for a limited period, thus ensuring a physician’s and patient’s goal coincides.

When administered in the office setting, the patient, caregivers and medical staff all participate in the pre and post block assessments. This team approach enables the patient to achieve optimal results and shows the patient what they can expect to achieve as a long-term result. Working together as a team improves outcomes.

Case Studies

On any given day, the variety of patients seeking relief from the affects of spasticity can range in age and require a variety or treatment modalities, including the following:

Katie, a 21-year-old patient suffering from spasticity as the result of a traumatic brain injury. Specifically, the patient seeks to improve function and relief from spasticity in her fingers and toes. Using electromyography (EMG) as guidance, injections can be precise and placed in the location where the most spasticity occurs. In the five years since Katie has received injections, she has achieved outcomes that surpass her original goals.

Amy, a 48-year-old young stroke survivor with right hand paraparesis. Four months post-injection, this patient continues seeing positive results with a fully functioning hand, including fine motor skills. Improvement continues and as a result no treatment was required at this visit.

Helen, a 78-year-old stroke survivor with a stiff arm and foot drop. The patient suffers from recurring spasticity affecting range of motion and function. The last treatment on the patient’s calf to alleviate foot drag was one year ago and no further treatment is required at this time. The arm stiffness is treated on a twelve week cycle, using an EMG to guide injections to the location where the greatest spasticity occurs.

John, 65-year-old with left hemiparesis as a result of a spinal cord injury. Following a diagnostic block, the patient receives an intramuscular phenol injection to reduce reflex contraction and spasticity. Phenol injections react on an entire muscle group with a single injection; thus requiring fewer injections.

Patients who receive a phenol injection require regular return visits, usually three times a year. Currently, the Center for Tone Management that is part of Bryn Mawr Rehab Hospital treats upwards of six patients each day on an inpatient basis. Additionally, upwards of 100 nerve blocks are completed each week on an outpatient basis, similar to the case studies previously mentioned. This is the tip of the iceberg compared to the number of individuals who suffer with spasticity as a result of brain injury, stroke, spinal cord injury, multiple sclerosis, cerebral palsy and other neurological injuries and diseases.

For more information on the treatment of spasticity and the Center for Tone Management, contact Dr. Paulin.