aha spasticity and hypertonicity - clinical...
TRANSCRIPT
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TheUnrelen.ngMispercep.onsofSpas.cityandHypertonicity:ClinicalApplica.on
BethFisher,PT,PhD,FAPTARyanFrendewey,PT,DPT,NCSJosephRobinson,PT,DPT,NCS
AHA,Inc.Interna.onalConference"PiecingTogetherOurFuture"
Hilton,FortCollins,ColoradoMarch9th-11th,2017
OutlineforToday’sPresenta.on
• Clinicalmanagement:amovementre-educa.onperspec.veversusaspas.city/toneperspec.ve
Whatistheproblem?
• Spas.cityandhypertonicityerroneouslylinkedtovoluntarymovementcapability
• Spas.cityandhypertonicityusedsynonymously• Theissuesremainintheforefrontofourclinicalconversa.ons
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TheEvidenceThereisnoconvincingevidencethathypertoniaorspas.cityinterferewithvoli.onalmovement
Time To Move Forward
“So,Iignorehypertoniaandspas3cityandmaintainjointmobility...That’sit?”
ClinicalApplica.on:MovementAssessment&Re-educa.on
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Objec.ves
• U.lizeamorecontemporaryandevidence-basedframeworkformanagingthepa.entwithmovementdysfunc.on
• Discussmovementdevia.onswithaccuratedescriptorsthathelpguidefurthermovementassessment
“Theilliterateofthetwenty-firstcenturywillnotbethosewhocannotreadandwrite,butthosewhocannotlearn,
unlearnandre-learn.”–AlvinTofflerIftheevidenceconsistentlydemonstratesthatspas.cityandhypertonicityarenotthedirectcauseofmovementdysfunc.on,whydowepersistinassessmentandinterven.on
oftheseimpairmentswithrela.ontomovementdysfunc.on?
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Historical
Assessments
Condi.onsthatPromoteChange
1. Currentapproachesarenotadequatetosolveclinicalproblemsperceivedbytherapists.
2. Theore.calassump.onsunderlyingcurrentapproachesdonotfitcurrentknowledge.
Gordon,JG.Assump.onsUnderlyingPhysicalTherapyInterven.on_2ndEd
Gordon,2000
Pa.ent’sGoal
PhysicalExam
Spas.city
Hypertonicity
MovementAnalysis
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Wernicke-MannSyndromeApostureanomalywithpar.alhemiplegiaoftheextremi.escharacterizedbytypicalpostureandgaitdisorders.Thehandandfingerisheldadducedwiththelowerarmedflexed,thelegisstretchedwithplantarflexionofthefoot,sothatitmovesinacurvedway.Itiscausedbylesionsofthecentralnervoussystemresul.ngincontralateralspas9cparalysisofthemusclesofupperandlowerlimbsandface.hhp://www.whonamedit.com/synd.cfm/899.html
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MovementAssessmentGoal
MovementDiscovery
“Don’tDoThat”
ChangeDemand
Devia9onIsola9on
Tac9leCueing
ModifiedTask
ImpairmentMi9ga9on
Physical,environmental,orcogni.veconstraintsthatmaymaskcapability
ImproveROMand/orstrengthtomeetrequirementsofmovementgoal
Manualfacilita.onthatmodifiesperformancebyreducingcompensa.onorimprovingperformance
Anewtaskthatputstheemphasisonakeydevia.onseenintheprimarytask
Quickverbalfeedbacktoseeifthepa.entcanreduceagivencompensa.on
Keydevia.onisisolatedandtakenoutoffunc.onalcontext
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“Puttheringonthepole”
“Keepyourbackagainstthechairnext.me”
“Don’tDoThat”
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Historical:Kneeextensorandplantarflexorspas.cityorhypertonicitylimitsherabilitytostand
Proposed:Decreasedanteriorweightshimtofeetlimitshercapacitytoperformtask.
ChangeDemand
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Historical:Spas.cityorHypertonicityofthekneeextensorsorplantarflexorsdrivesthekneeintoearlyextensionProposed:Posi.onofthegroundreac.onforceanteriortothekneejointpromotesakneeextensionmoment.
Devia9onIsola9on
ChangeDemand
ImpairmentMi9ga9on
PREPOST
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Historical:Elbowflexorhypertonicityand/orspas.citylimitselbowextension
Proposed:Ini.ateswithscapulareleva.onbecausethephysicaldemandofthetaskismaskinghiscapacity
Devia9onIsola9on
SecondaryTask
ChangeDemand
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SecondaryTask
ChangeDemand
Devia9onIsola9on
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ChangeDemand
SecondaryTask
ChangeDemand
Devia9onIsola9on
ImpairmentMi9ga9on
“Don’tDoThat”
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Researchers
Academia
CliniciansPa.ents
Summary
#CSMNeuro#Mispercep.onCSM
“Weneedtoteachourselvestheanaly3calskillsnecessaryformakingasophis3catedbiomechanicalandfunc3onalevalua3onofourpa3ents’movementdisorders.”-JamesGordon,2000
Iftheevidenceconsistentlydemonstratesthatspas.cityand
hypertonicityarenotthedirectcauseofmovementdysfunc.on,whydowe
persistinassessmentandinterven.onoftheseimpairmentswithrela.onto
movementdysfunc.on?
#CSMNeuro#Mispercep.onCSM