Definition of Success in Post-Stroke Spasticity Management – How to Achieve Success?
Spasticity, that frequently affects stroke patients, is usually defined as a velocity dependent increase in muscle tone. In association with muscle paresis and fixed contracture, spasticity may cause typical pattern affecting both upper limb (elbow flexum, spastic hand) and/or lower limb (stiff knee gait, equinovarus foot). These spastic patterns interfere with function (gait and prehension) and cause discomfort (hygiene, dressing) and/or pain.
A complete clinical examination is a necessary step before a specific spasticity treatment could be proposed in order to define the most appropriate treatment and to determine with the patient the expected and clearly defined goal to reach. Such goal that will vary from one patient to another may be the first step to success. In accordance with the International Classification of Functioning, Disability and Health (ICF) of the World Health Organization (WHO), treating spasticity, which is a body function & structure problem, is a way to improve activities and most of all the quality of life and participation of the patient. A good quality of life could be considered as the final step to success.
The treatments of the spasticity are multimodal. Medical treatments include intensive rehabilitation (stretching, neuro-muscular electrical stimulation, TENS therapy), oral medications, chemical denervation (botulinum toxin, phenol, alcohol) and orthosis. Surgical treatments include functional neurosurgery (intra-thecal baclofen therapy and neurotomy) frequently associated to orthopaedic surgery (tendon lengthening, tendon transfer, arthrodesis). All these treatments cannot be performed by only one specialist. This emphasizes the need for an interdisciplinary management of the spasticity which can be called a “spasticity group”. In our hospital, the spasticity group is composed of a MPR specialist (with the rehab team including physical therapist, occupational therapist and ortho-prosthetist), a neurosurgeon, an orthopaedic surgeon, a neurologist and an anesthetist.
In conclusion, an appropriate spasticity treatment is a way to achieve practical goal determined with the patient which is the key to success. An interdisciplinary management of the spasticity is mandatory in order to offer the most appropriate treatment to our patients.
Keywords: hemiplegia, muscle spasticity, interdisciplinary