And what definition of 'Spasticity' is everyone using these days?
----- Original Message -----
From: "Geoff" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Sunday, September 08, 2002 8:49 PM
Subject: Re: WHEIGHT BEARING AND SPASTICITY
> I think the answer to the question of spasticity depends on the
> individual client. If increased muscle tone allows a person to stand or
> perform other functional tasks without too much interference, then
> spasticity can be a good thing. If the spasticity leads to unsafe
> positioning or contracture of a limb, or interferes with functional
> movement, then it must be dealt with appropriately.
> If a child's foot is posturing into equinovarus while placed on a
> footrest, you can take steps to alleviate this. Pressure relieving
material
> such as foam or gel pads can be secured to the footrest to evenly
distribute
> foot pressure away from the metatarsal heads. Angle adjustable footplates
> can be used to accomodate any contractures. You must be careful, however,
> to not promote contractures of the foot and ankle. I'm afraid taking away
> footrests may actually promote the contractures you're working to avoid.
If
> positioning does not help with relaxation of the equinovarus, then the
> child's neurologist should be consulted for medication changes and/or
botox
> injections. In severe cases, tendon releases or dorsal rhizotomy may be
> needed to prevent permanent contracture and ankylosis.
> Before proceding with such endeavors, however, the therapist, patient,
> and family should discuss what their goals are. How is the child's
> prognosis for walking? What can the child do functionally that would be
> hindered by contracture? These are important questions to ask before
> deciding on a treatment path. Perhaps contracture is the lesser of evils
> compared with an alternative of invasive surgery in some cases. If the
> child is able to function at the best of his cognitive and motor
abilities,
> then management of a severe contracture may not always be necessary.
Other
> things to consider are issues of hygeine, difficulty for caregivers to
move
> and position the child, and the potential for skin breakdown.
> I think too many times, children are aggressively managed without
careful
> consideration of all the options. My apologies, I digress.
> Back to the original quandry, I think taking away all weight bearing on
a
> foot just to prevent spastic positioning may actually promote the very
thing
> you are trying to avoid. The most severe ankle/foot contractures I have
> ever seen are in persons who have had no weight bearing at all over
extended
> periods. Weight bearing actually helps to normalize tone if used
> functionally.
> Spasticity has been shown to decrease with improved functional mobility
> of the limb. If you avoid weight bearing, how are you supposed to improve
> function of a leg, whose main purpose in life is to bear weight?
> Sorry for the long winded answer. I hope I haven't opened a can of
worms
> for you.
>
> Warm regards,
> Geoff Mosley, PT, NCS
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