Upper Motor Neurone Syndrome and Spasticity: Clinical Management and Neurophysiology

Half-title......Page 3
Title......Page 5
Copyright......Page 6
Contents......Page 7
Contributors......Page 9
Preface to the second edition......Page 11
Positive phenomena of the UMN syndrome......Page 13
Soft tissue changes and contractures......Page 14
Spastic dystonia and associated reactions......Page 15
Pain......Page 16
The physiotherapist and the orthotist......Page 17
Intrathecal and surgical techniques......Page 19
REFERENCES......Page 20
Definition......Page 21
Descending pathways: upper motor neurones......Page 22
Excitatory system......Page 23
Descending motor pathways in the spinal cord......Page 25
Clinicopathological correlation......Page 26
Mechanism of the change in excitability of the spinal reflexes......Page 27
Phasic stretch reflexes......Page 28
Tonic stretch reflexes......Page 29
Static tonic stretch reflexes......Page 33
Tonic stretch reflexes during muscle activation......Page 35
The physiological mechanisms underlying stretch reflex hyperexcitability......Page 36
Nonreflex contributions to hypertonia: biomechanical factors......Page 37
Flexor reflex afferents......Page 40
Flexor spasms......Page 42
The extensor plantar response......Page 43
Extensor reflexes and spasms......Page 44
Associated reactions......Page 45
Spastic co-contraction......Page 46
Spastic dystonia......Page 47
H reflexes......Page 50
Ia Presynaptic inhibition......Page 52
Ia Reciprocal inhibition......Page 54
Ib Nonreciprocal (autogenic) inhibition......Page 55
Recurrent (Renshaw) inhibition......Page 57
Alpha motoneurone excitability......Page 59
Ia Polysynaptic excitatory pathways......Page 61
Group II polysynaptic excitatory pathways......Page 62
Conclusion regarding spinal mechanisms in the UMN syndrome......Page 63
The spastic movement disorder......Page 64
REFERENCES......Page 66
Introduction......Page 76
The Ashworth scales......Page 77
Ashworth and modified Ashworth scales – level of measurement......Page 78
Modified Ashworth scale......Page 79
Ashworth scales – conclusions and recommendations......Page 80
The Tardieu method of assessment......Page 81
The Tardieu method of assessment – conclusions and recommendations......Page 82
Wartenberg test......Page 83
Powered systems......Page 84
Indirect biomechanical approaches – gait analysis......Page 85
Tendon jerks......Page 86
F waves......Page 87
REFERENCES......Page 88
What is spasticity?......Page 91
How important a determinant of activity limitations is spasticity?......Page 92
Confusion between spasticity and other impairments......Page 93
Effect of pathology and maturation on spasticity......Page 94
Assessment of spasticity......Page 96
Intervention......Page 97
Training of appropriate muscles......Page 99
Prevention of adaptive soft tissue changes......Page 101
Pharmacological and surgical options......Page 104
REFERENCES......Page 106
Introduction......Page 111
Sustained muscle stretch......Page 112
Maintenance of hip integrity......Page 113
Trunk orientation......Page 114
Restraint of arm movement......Page 115
Reduction of unnecessary upper limb activity......Page 116
Alternative postures......Page 117
Seat design and spasticity......Page 118
Adjustability......Page 119
Choosing seating systems......Page 120
Conclusion......Page 121
REFERENCES......Page 122
Introduction......Page 125
Preventing contractures and maintaining or increasing joint ranges......Page 126
Biomechanics and materials......Page 127
Plastic or metal orthosis?......Page 128
Assessment......Page 129
Casting......Page 131
Orthotics in paediatric management......Page 132
Ankle-foot orthoses......Page 133
Dynamic insoles and dynamic ankle-foot orthoses (DAFOs)......Page 134
Knee orthoses and knee-ankle-foot orthoses......Page 135
Hip and hip-knee-ankle-foot orthoses (HKAFOs)......Page 136
Cervical orthoses and the cervical spine......Page 137
The hemiplegic shoulder......Page 138
The hand and wrist......Page 139
Functional electrical stimulation (FES)......Page 140
REFERENCES......Page 141
Introduction......Page 143
Management strategy......Page 144
Outcome measures......Page 145
Baclofen......Page 147
Clinical efficacy......Page 148
Side effects......Page 149
Clinical efficacy......Page 150
Mechanism of action......Page 151
Dosage and administration......Page 152
Pharmacokinetics......Page 153
Dosage and administration......Page 154
Cannabis......Page 155
REFERENCES......Page 156
Introduction......Page 162
Indications for medial popliteal nerve blocks......Page 163
The pharmacological properties of neurolytic agents......Page 164
Nerve blocks......Page 165
Obturator nerve blocks......Page 166
Motor point injections......Page 169
Motor point blocks of the hip flexors......Page 170
The optimal concentration and dosage of the neurolytic agents......Page 171
Complications of peripheral nerve blocks......Page 172
Procedure of intrathecal block......Page 173
Summary......Page 174
REFERENCES......Page 175
Clinical pharmacology......Page 177
Assessment......Page 179
Dosage......Page 180
Long-term efficacy and safety......Page 181
Economics......Page 182
Botulinum alone or in combination?......Page 183
Clinical trials......Page 184
Other spasticity indications......Page 186
Associated reactions......Page 187
Conclusions......Page 188
REFERENCES......Page 189
Baclofen and pain......Page 193
Flexion reflex excitability......Page 194
General considerations......Page 195
Trial dose......Page 196
Implant surgery......Page 197
Multiple sclerosis (MS)......Page 198
Spinal cord injury (SCI)......Page 199
Cerebral palsy (CP)......Page 200
Effects of pump or catheter failure......Page 201
REFERENCES......Page 202
Neuroablative procedures......Page 205
Lower limbs......Page 206
Upper limbs......Page 208
Improvement of motor function......Page 209
Posterior selective rhizotomy......Page 210
Sectorial posterior rhizotomy......Page 211
The results of posterior rhizotomies......Page 212
Percutaneous thermorhizotomies and intrathecal chemical rhizotomies......Page 214
Surgery in the dorsal root entry zone......Page 215
Orthopaedic surgery......Page 220
In children with cerebral palsy......Page 221
REFERENCES......Page 223
The pathology of spasticity......Page 226
The dynamic and static joint range of motion......Page 229
Managing spasticity in children......Page 231
Diazepam......Page 233
Baclofen......Page 234
Intramuscular injections: chemoneurolysis: temporary/focal......Page 235
Selective dorsal rhizotomy: permanent/generalized......Page 236
Intrathecal baclofen (ITB): semipermanent/generalized......Page 237
Botulinum toxin A (BoNT-A): focal/temporary......Page 238
RCT 1: hemiplegic upper limb......Page 240
RCT 2: BoNT-A vs casting for dynamic equinus......Page 241
BoNT-A doses in children......Page 242
Orthopaedic surgery......Page 244
Conclusion......Page 245
REFERENCES......Page 246
Index......Page 253