Jane Raleigh, Physiotherapist, based in the Yorkshire Team, explains what spasticity is and how it is treated incorporating the 2015 Guidelines.
“Spasticity causes muscle tightness and joint stiffness which if left untreated, hinders normal movement. Consequently, this can negatively affect a person’s function and potential to achieve their rehabilitation goals.
Physiotherapists are experts in how the muscles and joints of the body work together to produce purposeful movement and therefore skilled in tailoring treatment plans incorporating manual techniques and exercise programmes. A core skill of a Physiotherapist working within neurology is Spasticity management and prevention and they are best placed to assess the need of adjuncts to therapy such as BOTOX injections, sleep systems, splinting and Lycra garments. These adjuncts help to promote carry over between physiotherapy sessions if used in conjunction with each other rather than as standalone treatment interventions.
During a Spasticity Management Study Day, i was introduced to the new 2015 guidelines which gave insight into the medical and physical treatment interventions when dealing with spasticity. The guidelines titled ‘Splinting for the prevention and correction of contractures in adults with neurological dysfunction’ are a collaboration between Physiotherapists (ACPIN) and Occupational Therapists (RCOT). They are aimed at providing the clinician with recommendations on the suitability of splinting in different patient presentations and intended to be utilise alongside clinical judgement. Follow this link for access to the guidelines: https://www.acpin.net/Splinting_Guidelines/Splinting_Guidelines.pdf
Such guidelines help to clinically reason the need for such intervention when managing and preventing spasticity however, it is also vital to remember that each person is an individual and a patient centred approach will aid compliance and help to provide an optimum package of treatment that is more likely to succeed. To illustrate, the use of splinting is an intervention commonly used in conjunction with BOTOX to help reduce muscle shortening and joint contractures. The patient and or carers must fully understand the importance of such intervention and if the patient and or carers are not compliant with positioning the splint post injection, then spasticity management and prevention is likely to fail. The key word in spasticity management and prevention is TEAMWORK! Click on the following link for further information on shared decision making: https://www.kingsfund.org.uk/publications/making-shared-decision-making-reality