Page 22 - Mobility Management, February 2018
P. 22

                                 ATP Series
Seating & Spasticity
“High tone or spasticity occurs when the muscle tension becomes tighter, which leads to the muscle(s) shortening. Reduced muscle length will affect the joint’s range of motion, and thereby the associated functional movement output. The joint will, in most cases, become  xed, and this is known as a contracture.”
The Impact on Daily Life
One reason that spasticity can be so dif cult to manage is that the condition can change, sometimes from moment to moment. Something as simple as rolling over a bump or being startled can cause an incident for a wheelchair user prone to spasticity.
“Environmental or extrinsic factors can indeed trigger spasticity,” Lucas said. “Spasticity can be triggered by tempera- ture, time of day, or anything really that causes pain or discom- fort. An improperly prescribed wheelchair and seating system can also be a trigger for spasticity. This includes positioning supports, the  t of the chair, material in the positioning equip- ment and suspension in the chair. The trick is to try to address these factors with the wheelchair and seating system in order to decrease the spasticity the individual experiences.”
“Spasticity can be exacerbated by sudden movements, position changes, extremes in temperature, humidity and infections,” Hoffman said. “When spasms or spasticity become problematic and interfere with the function or care of the individual, then other interventions may need to be considered.”
Unfortunately, spasticity can also be linked to pain — either directly causing it or exacerbating pain that already exists.
“Pain can often trigger an increase in pain, or the spasticity can be very painful itself,” Lucas said. “Thus, we try to set up the wheelchair seating and mobility system to decrease the spasticity itself, but also make sure that the materials or parts of the chair do not cause pain that may trigger the spasticity.
“Power positioning can have great bene ts with managing spasticity and should be considered with individuals who can bene t from its use. For example, for someone with  exor spas- ticity, the ability to recline the system may assist in stretching the muscles to decrease the tone. For an individual with extensor spasticity, power recline should be used with caution, as it could elicit the tone. However, for someone with strong extensor tone, who is pushing into the seating system, the use of power recline may provide an outlet for the body, somewhat like a dynamic seating system, and minimize the amount of time they are actively pushing into extension.”
Managing Spasticity Situations
Lucas noted that spasticity should be strongly considered when the seating and mobility team is choosing equipment.
“In fact, spasticity is a major factor in the decision-making process for the seating and mobility equipment recommen- dations,” he said. “Spasticity is very much dependent on the position of the body. The seating system is set up to support the individual in a position that inhibits or decreases the spasticity.
Some of these recommendations could include angles of back- rest/legrests, shape of cushion, amount of support, and suspen- sion in the wheelchair.”
The team could also have to consider how a client’s spasticity will present in the future, Lucas said, because in some cases, spasticity can be expected to worsen.
“This depends on the condition causing the spasticity to occur,” he said. “If the person has a progressive condition, such as multiple sclerosis, then the severity of the spasticity will likely change or progress. If the spasticity is caused by a single event (spinal cord injury, cerebral palsy, etc.), then the severity of the spasticity typically would not progress.”
Spasticity interventions should be considered when “the secondary complications, such as increased muscle tightness, negatively impact and impair function and lead to increased pain, creating a snowball effect which, in turn, results in increased care needs and positioning dif culties,” Hoffman said.
When it comes to overall intervention, she added, the best approach can be a multi-pronged one.
“Whilst there is a myriad of treatment modalities applied to addressing spasticity and the resulting symptoms, not one inter-
For an individual with extensor spasticity, power recline should be used with caution, as it could elicit the tone —Wade Lucas
vention alone is a suitable solution in the holistic management of the individual,” Hoffman said. “Treatment methods should ideally be inclusive of prevention. The treatment ranges from non-invasive therapeutic interventions, splinting, positioning, oral medications and injectables to more invasive treatment approaches, i.e., surgical interventions.”
Regardless of how the consumer, family members, physicians and the seating and mobility team decide to act, it’s critical to  nd a way to manage spasticity — and that includes using seating and wheeled mobility technology to intervene, Lucas said.
“Spasticity can signi cantly affect a person in many ways. Due to the tightening and the effect that it has on voluntary muscle control, the person could have dif culty completing normal everyday activities, such as their activities of daily living, completion of mobility (gait or wheelchair), or speaking. This decreases their independence and increases the reliance on caregivers.
“Spasticity can also cause signi cant postural asymmetries, placing the individual at risk for complications such as pressure injuries and non-correctible reducible deformities. As mentioned previously, spasticity can be triggered by or cause pain. This causes decreased tolerance for daily activities and may require the increased use of medications. Therefore, it is important for clinicians and
ATPs to complete a comprehensive evaluation to assess the postural support needs and positions that limit/inhibit spasticity.” m

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