By David A. Gelber, Douglas R. Jeffery
David A. Gelber, MD, and Douglas R. Jeffery, MD, have assembled a much-needed number of authoritative evaluation articles discussing the pathophysiology of continual neurologic spasticity and detailing its usually advanced scientific and surgical administration. Written by means of prime specialists in neurology and rehabilitation, the e-book covers actual and occupational treatment, splinting and orthotics, electric stimulation, orthopedic interventions, nerve blocks, using botulinum toxin, and novel remedies resembling tizanidine, intrathecal drugs, and neurosurgical options. The participants additionally overview coordinated methods to the remedy of spasticity and particular neurological ailments corresponding to spinal wire harm, a number of sclerosis, stroke, cerebral palsy, and anxious mind harm.
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Additional info for Clinical Evaluation and Management of Spasticity (Current Clinical Neurology)
Sample text
Raw EMG signals are usually averaged and rectified for analysis. Simultaneous recordings are often made from multiple muscles, including agonist and antagonist groups. The onset and duration of contraction in response to a variety of self-initiated and induced movements may be recorded. Examples include muscle contraction in response to motor-nerve stimulation (46–48), stimulation of sensory nerves (49), or stimulation of the skin (50). Novel techniques include calculating the vector sum of EMG magnitudes, and the index of EMG focus, a measure of the range of EMG activation recorded for each load level (51).
Reports from caregivers are particularly important in persons with cerebral causes of spasticity who are cognitively impaired. Exacerbating conditions should be treated aggressively. The first line of defense against spasticity is to remove those factors that exacerbate it. Table 2 outlines common exacerbators of spastic hypertonia. A careful history and physical examination can often elicit modifiable factors to improve the patient’s clinical status. Perhaps the most common is pain, often related to the musculoskeletal complications of hypertonia.
Zhang and colleagues have used similar technology to measure the relationship between muscle torque and joint angle at different velocities of movement (35–37). Mechanical recording of this type requires even more complex equipment and therefore such techniques have been relegated to research laboratories. The problem with all biomechanical spasticity measures is that they do not readily differentiate between reflex and intrinsic (soft tissue) contributions to muscle tone. Many authors feel that changes in both reflex and 36 Good Fig.