Page 21 - Mobility Management, February 2018

skeletal muscles. This results in increased muscle tone, hyperac- tive re exes, and pain. This tone, hyperactive re exes and pain can be triggered by a number of environmental stimuli, with spasticity resulting.
“Any diagnosis that has caused damage to the upper motor neurons can cause spasticity in the individual,” Lucas said.
In practical terms — such as how it could look during that seating evaluation — Hoffman said, “Spasticity is characterized by selected muscles continuously contracting. This contraction results in stiffness or tightness of the muscles, thereby interfering with typical or normal movement, speech and gait. Spasticity negatively affects both the muscles and joints of the extremities (AANS 2017).
It is also worth noting that, albeit challenging to manage in the seated orientation at times, spasticity is not all bad!
Usually, upper motor neuron lesion (UMNL) signs are viewed as a negative occurrence, resulting in spasms, spasticity and pain. This is not always the case, as many individuals make use
of spasticity to recruit for movement such as transfers, standing and walking. Orthotic devices may be employed to assist in harnessing the correct joint and limb alignment while making the most use of this UMNL phenomenon.
Lying Postural Orientations
It is vital to consider that many of the individuals who make use of therapeutic positioning during the daytime often spend in the region of eight to 12 hours a day in bed, lying in unsupported, asymmetrical, destructive postures, which negate the gains and bene ts of good positioning during the daytime (Lange 2009).
Night-time therapeutic positioning during rest and sleep hours is an effective intervention that continues to promote the daytime positioning and postural gains achieved. Night-time positioning
Cost savings can be achieved by implementing 24-hour posture management plans, equipment and protocol
supports are gentle and provide stability in the lying position with the aim of protecting body shape. The use of both informal and formal supports thus have application and bene t in providing gentle positioning and a stable postural base.
Pope (2007b) undertook work with individuals with multiple scle- rosis (MS) who presented with largely reduced or minimal ability
to independently move or change their position. Health profes- sionals with extensive experience in the eld, such as Pope (2007b), share their clinical experience in providing effective night-time positioning and postural supports for people with MS. Supports such as a T-roll can assist in providing stability and postural
control. It is essential that the correct size and application of the postural support equipment is provided to ensure that it assists
in controlling the spasms/spasticity in the lower limbs without restricting movement available to the individual. With the introduc- tion of postural support equipment, the movement following the spasticity-sequenced movement pattern will enable the individual to settle back into a more ‘relaxed,’ yet corrected position due to the postural support offered by the device (Pope 2007a and b).
Equipment and supports used over the 24-hour period aim to provide the individual with support to help control movement
and positioning/position changes (Porter et al 2007, 2010), the regulation of temperature and thermoregulation — all the while providing positioning to protect body shape (Clayton et al 2017) and promote hip health (Pountney et al 2002, Picciolini et al 2009) and prevent lateral spine curvature (Pope 2007a, Clayton 2017).
Noninvasive and Invasive Treatment:
Polypharmacy & Surgery
Posture management is part of the treatment intervention that is used in conjunction with tone-reducing medication. Medication alone is rarely able to address and improve outcomes.
Oral medication used in the treatment of spasticity includes Baclofen, Benzodiazepines, Dantrolene sodium, Imidazolines and Gabapentin.
Injectables, such as Botulinum toxin type A, are used for the treatment of focal spasticity.
Intrathecal interventions: Baclofen/Phenol pumps are treatment modalities considered when oral medication is deemed to not have the desired impact on the management of spasticity.
Surgery has an important role in the management of chronic spasticity. Selective dorsal rhizotomy and/or orthopaedic surgery are surgical interventions undertaken. Orthopaedic surgery is
a treatment pathway undertaken to repair the negative effects resulting from spasticity, such as hip dislocation. Orthopaedic interventions may be required to release tendons, fuse joints
or cut bones — however, this does not address the underlying neurological phenomenon. It is important to note that post-surgery postural management is required to assist with recovery and maintaining the surgical corrections achieved over the long term.
Food for Thought
Gough (2009) stated, “Children with disability become adults with disability; we need to develop a paradigm of postural manage- ment that will enhance their environment and participation as children [and] will continue to be effective as they become adults, [so they aren’t] facing potential isolation and a loss of support.” Equally — we are faced with a large aging population with co-morbidities who are living longer due to advances in medical interventions and treatment.
If we know that spasticity is a major contributing factor to problematic biomechanical changes and how it interferes with the function and care of the individual, then surely we need to consider all interventions, especially preventative measures, in our resource-limited climate that we currently nd ourselves in?
Isn’t it time you considered a 24-hour posture management approach for the individuals you serve?
— Lee Ann Hoffman, OT, MSc
MobilityMgmt.com MOBILITY MANAGEMENT | FEBRUARY 2018 19