Seminar-2-01-02
COMPREHENSIVE MANAGEMENT OF SPASTICITY IN THE PATIENT WITH TRAUMATIC BRAIN INJURY
Ivanhoe CB; Francisco GE; Yablon SA; Wiggs L
The spasticity treatment in patients with traumatic brain injury is best managed through an interdisciplinary team approach. Techniques such as serial/inhibitory casting, forced use activities, myofascial release, motor point blocks, botulinum toxin, intrathecal baclofen comprise a large portion of the spasticity management armamentrarium. Oral medications are falling out of favor for spasticity management in this patient population. Clinical scenarios and options will be discussed. IVANHOE CINDY B, M.D.: BAYLOR COLLEGE OF HEDICINE/THE INSTITUTE FOR REHABILIATION AND RESEARCH
FRANCISCO GERARD E, M.D.: UNIVERSITY OF TEXAS/THE INSTITUTE FOR REHABILITAION AND RESEARCH
YABLON STUART A, M.D.: UNIVERSITY OF MISSISSIPPI
WIGGS LAURA, P.T.: THE INSTITUTE FOR REHABILITATION AND RESEARCH
Seminar-2-01-03
Advancement in the Treatment of Spastic Gait in Traumatic Brain Injury
A. Esquenazi, M. Talaty and B. Hirai, N. Mayer (MossRehab Hospital & Temple University, Philadelphia, PA, USA)
Abstract: Patients with an upper moroneuron syndrome caused by traumatic brain injury commonly develop spasticity and lower limb restricted motion. The normal parameters of gait and its function are affected by this problem. Multi-channel dynamic electromyography, temporo-spatial parameters and kinetic data were used to study abnormal gait patterns in this population. Six generic problems that interfere with walking emerged: ankle equinus with or without varus and toe flexion, stiff knee, flexed knee, flexed hip, adducted hip and sustained hallux extension. Predicting the muscular cause of the deformity without EMG is extremely difficult and clinically inappropriate. Several treatment options are available and include chemodenervation with botulinum toxin, neurolysis with phenol, orthopaedic tendon transfers, lengthenings and releases and physiotherapeutic strategies that improve motion resulting in improved gait. Case presentations will be used during this presentation.
