Spasticity Instructional Course:
Tracks
Risso 7
| Thursday, November 7, 2019 |
| 2:40 PM - 4:10 PM |
| Risso 7 |
Overview
The Troublesome Trio of Spasticity: Clonus, Spasms, Stiffness – Attributes, Pathophysiology, and Non-Pharmacologic Management
Speaker
Prof Edelle Field-Fote
Director Of Spinal Cord Research
Shepherd Center
The Troublesome Trio of Spasticity: Clonus, Spasms, Stiffness – Attributes, Pathophysiology, and Non-Pharmacologic Management
Abstract
Spasticity is one of the most prevalent and problematic secondary conditions experienced by persons with spinal cord injury (SCI). It is reported by a majority of those with chronic SCI, and usually develops within the subacute phase following injury. There are several neurophysiolgic mechanisms that account for the development of spasticity, and there is some evidence that spasticity may share some mechanisms in common with neuropathic pain. There are multiple definitions of spasticity, some of which have a limited relationship with the way this phenomenon is experienced by persons with SCI. For example, hyperactive stretch reflexes (ie, clonus) are rarely the reason individuals with SCI seek treatment. While the clinical presentation of spasticity varies from person to person, stiffness and spontaneous spasms are more likely to be the characteristics cited as problematic While spasticity can have a detrimental influence on function and quality of life, it can be associated with some benefits, such as preservation of muscle mass, postural support, or triggering a spasm to assist with limb movement. Investigators at six SCI Model System Centers in the United States collaborated on a survey study to identify what features are most problematic and whether there are patient-reported beneficial aspects. Survey results from over 1,200 individuals with SCI will be presented, along with a discussion of current theories related to the underlying mechanisms, and recent evidence regarding physical therapeutic interventions that are promising for the management of spasticity after SCI.
Course Outline (90 mins):
20 min: definitions of spasticity, why definitions matter, and the qualities of spasticity as characterized by individuals with SCI (Kirshblum)
20 min: relationship between self-reported spasticity, and perceived functional and quality of life measures (Kirshblum)
20 min: physiologic mechanisms of spasticity (inhibitory modulation, Cl- disequilibrium, 5HT receptors) (Field-Fote)
20 min: promising physical therapeutic interventions for spasticity management (Field-Fote)
10 min: Open Forum
Course Outline (90 mins):
20 min: definitions of spasticity, why definitions matter, and the qualities of spasticity as characterized by individuals with SCI (Kirshblum)
20 min: relationship between self-reported spasticity, and perceived functional and quality of life measures (Kirshblum)
20 min: physiologic mechanisms of spasticity (inhibitory modulation, Cl- disequilibrium, 5HT receptors) (Field-Fote)
20 min: promising physical therapeutic interventions for spasticity management (Field-Fote)
10 min: Open Forum
Biography
In her role the Director of SCI Research at Shepherd Center, Dr. Field-Fote leads a team dedicated to improving motor function in persons with SCI through the development of neuro modulation and neurorehabilitation approaches informed by the latest neuroscience research and guided by outcomes that have meaning for persons with SCI. Her contributions to the SCI literature include the largest study to date of locomotor training for persons with chronic, motor-incomplete SCI, and the first-ever study of a rehabilitation intervention to promote neuroplasticity for improved hand function in persons with tetraplegia. With a clinical background as a physical therapist and PhD training in a pre-clinical model of SCI, her 20+ years of SCI research has spanned the breadth of basic and clinical research related to SCI. Dr. Field-Fote currently serves on the NIH National Advisory Board on Medical Rehabilitation Research, and her work has been funded by the NIH since 1997; other projects in her lab are funded by the Department of Defense, and the National Institute on Independent Living Disability and Rehabilitation Research. Dr. Field-Fote is the editor/chapter author of the textbook Spinal Cord Injury Rehabilitation (FA Davis Publishers), associate editor/chapter author of textbook Spinal Cord Medicine (Kirshblum & Lin, eds; Demos Medical Publishers). She currently serves as Editor-in-Chief of the Journal of Neurologic Physical Therapy, and as Project Director of the Southeastern Regional Spinal Cord Injury Model System.
