Clinical Evaluation and Management of Spasticity 1st Edition by Robert Young, David Gelber ISBN 0896036367 978-0896036369
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ISBN 10: 0896036367
ISBN 13: 978-0896036369
Author: Robert Young, David Gelber
David A. Gelber, MD, and Douglas R. Jeffery, MD, have assembled a much-needed collection of authoritative review articles discussing the pathophysiology of chronic neurologic spasticity and detailing its often complex medical and surgical management. Written by leading experts in neurology and rehabilitation, the book covers physical and occupational therapy, splinting and orthotics, electrical stimulation, orthopedic interventions, nerve blocks, the use of botulinum toxin, and novel treatments such as tizanidine, intrathecal medications, and neurosurgical techniques. The contributors also review coordinated approaches to the treatment of spasticity and specific neurological diseases such as spinal cord injury, multiple sclerosis, stroke, cerebral palsy, and traumatic brain injury.
Clinical Evaluation and Management of Spasticity 1st Table of contents:
I Basic Concepts of Spasticity
1 Physiology and Pharmacology of Spasticity
CLINICAL PHYSIOLOGY OF SPASTICITY
PATHOPHYSIOLOGY OF SPASTICITY
PHARMACOLOGY OF SPASTICITY
SUMMARY
REFERENCES
2 Clinical Features of Spasticity and Principles of Treatment
INTRODUCTION
DEFINITION AND APPROACH TO THE PATIENT
SYMPTOMS AND SIGNS OF THE UMN SYNDROME
TREATMENT OF SPASTICITY
CONSIDERATIONS IN TREATMENT
TREATMENT
REFERENCES
3 Measurement of Spasticity
INTRODUCTION
COMPLICATING FACTORS IN THE MEASUREMENT OF SPASTICITY
REASONS TO MEASURE SPASTICITY
ROUTINE CLINICAL EVALUATION OF SPASTICITY
BIOMECHANICAL EVALUATION
ELECTROPHYSIOLOGICAL EVALUATION
RELEVANCE TO OTHER CLINICAL-OUTCOME MEASURES
SUMMARY
REFERENCES
II Treatment Modalities
4 Physical and Occupational Approaches
INTRODUCTION
PHYSICAL APPROACHES TO THE MANAGEMENT OF SPASTICITY
THEORETICAL BASIS OF THERAPEUTIC EXERCISE TECHNIQUES IN SPASTICITY MANAGEMENT
SUMMARY
REFERENCES
5 Orthotic Management
INTRODUCTION
NOMENCLATURE AND CLASSIFICATION OF ORTHOSES
CLINICAL BASIS FOR ORTHOTIC INTERVENTION
WRIST HAND FINGER ORTHOSES
ELBOW ORTHOSES
ANKLE FOOT ORTHOSES
KNEE ORTHOSES
KNEE ANKLE FOOT ORTHOSES
HIP ORTHOSES
SUMMARY
REFERENCES
6 Electrical Stimulation
INTRODUCTION
HISTORY
TREATMENT OF HEMIPLEGIA
TREATMENT OF SPINAL-CORD INJURY
TREATMENT OF MS
TREATMENT OF CP
SUMMARY
REFERENCES
7 Baclofen
INTRODUCTION
CHEMISTRY
CELLULAR LEVEL MECHANISM OF ACTION
CENTRAL NERVOUS SYSTEM LEVEL MECHANISM OF ACTION
PHARMACOKINETICS
ADVERSE EFFECTS
TOXICITY
ADVERSE EFFECTS SECONDARY TO WITHDRAWAL
DOSAGE
CONCLUSIONS AND FUTURE DIRECTIONS
REFERENCES
8 Tizanidine
INTRODUCTION
PHARMACOLOGY
PHARMACOKINETICS
EFFICACY STUDIES
SIDE EFFECTS
ADMINISTRATION
PRECAUTIONS AND DRUG INTERACTIONS
OTHER CLINICAL USES OF TIZANIDINE
SUMMARY AND CONCLUSIONS
REFERENCES
9 Benzodiazepines
INTRODUCTION
HISTORY
MECHANISMS OF ACTION
PHARMACOLOGY
CLINICAL TRIALS
ADVERSE EFFECTS
ADMINISTRATION
CONCLUSIONS
REFERENCES
10 Dantrolene
INTRODUCTION
MECHANISM OF ACTION
INDICATIONS AND USAGE
RISKS AND ADVERSE AFFECTS
SUMMARY
REFERENCES
11 Alternative Pharmacologic Therapies
INTRODUCTION
ALPHA2-ADRENERGIC AGONISTS
ALPHA ADRENERGIC BLOCKING AGENTS
ANTICONVULSANTS
VALPROIC ACID
DRUGS CHEMICALLY RELATED TO GABA
NMDA-ANTAGONISTS
MISCELLANEOUS DRUGS
CONCLUSION
REFERENCES
12 Nerve Blocks
INTRODUCTION
NERVE BLOCKS
BENEFITS OF NERVE BLOCKS
TIMING OF NERVE BLOCKS
PHENOL
ETHANOL
LOCAL ANESTHETICS
POTENTIAL ADVERSE EFFECTS OF NERVE BLOCKS
TYPES OF NERVE BLOCKS AND TECHNIQUES
PATIENT SELECTION AND EVALUATION
CARE AFTER NERVE BLOCK
SUMMARY
REFERENCES
13 Botulinum Toxins
INTRODUCTION
MECHANISM OF ACTION
PREPARATION OF BTX-A FOR INJECTION
INJECTION TECHNIQUES
PHENOL VS BOTULINUM TOXIN
MUSCLE SELECTION AND DOSE RANGES
TREATMENT OBJECTIVES
CLINICAL TRIALS
CONTRAINDICATIONS
FUTURE RESEARCH IN SPASTICITY
REFERENCES
14 Intrathecal Medications
INTRODUCTION
HISTORY OF INTRATHECAL MEDICATIONS
CLINICAL TRIALS OF INTRATHECAL BACLOFEN
PATIENT SELECTION
PUMP-IMPLANTATION PROTOCOL
COMPLICATIONS
OTHER INTRATHECAL MEDICATIONS
SUMMARY
REFERENCES
15 Orthopedic Interventions for the Management of Limb Deformities in Upper Motoneuron Syndromes
INTRODUCTION
EVALUATION OF SPASTIC-LIMB DEFORMITIES
CLINICAL EVALUATION OF MOTOR CONTROL
LABORATORY ASSESSMENT OF MOTOR CONTROL
ORTHOPEDIC MANAGEMENT OF COMMON DEFORMITIES
REFERENCES
16 Neurosurgical Management
INTRODUCTION
PERCUTANEOUS NEUROTOMY
SELECTIVE OPEN NEUROTOMY
ANTERIOR RHIZOTOMY
PERCUTANEOUS RADIOFREQUENCY FORAMINAL RHIZOTOMY
MYELOTOMY
SELECTIVE SPINAL CORDECTOMY
ABLATIVE INTRATHECAL SCLEROSING AGENTS
STEREOTAXIC ABLATIVE PROCEDURES
DORSAL RHIZOTOMIES
REFERENCES
III A Coordinated Approach to the Treatment of Spasticity in Neurologic Diseases
17 Management of Spasticity in Children with Cerebral Palsy
INTRODUCTION
EDUCATIONAL PLANNING
ASSESSMENT AND TREATMENT OF SPASTICITY
FUTURE DIRECTIONS
REFERENCES
18 The Evaluation and Treatment of Spasticity in Patients with Multiple Sclerosis
INTRODUCTION
ORIGINS OF SPASTICITY IN MS
FUNCTIONAL CONSEQUENCES OF SPASTICITY
APPROACH TO THE TREATMENT OF SPASTICITY IN MS
SPECIFIC AGENTS USEFUL IN SPASTICITY IN THE MS PATIENT
ALTERNATIVE AND ADJUNCT THERAPIES FOR SPASTICITY IN MS
SUMMARY
REFERENCES
19 The Development and Management of Spasticity Following Traumatic Brain Injury
INTRODUCTION
PATHOPHYSIOLOGY OF TRAUMATIC BRAIN INJURY
INDICATORS OF OUTCOME AFTER TBI
PATTERNS OF RECOVERY AFTER TBI
SPASTICITY IN ACUTE TBI
CONTRACTURES
FRACTURES
HETEROTOPIC OSSIFICATION
SPASTICITY IN SUBACUTE AND CHRONIC TBI
THERAPEUTIC INTERVENTIONS FOR FOCAL SPASTICITY
LOCAL PHARMACOLOGIC TREATMENT OF SPASTICITY
SYSTEMIC PHARMACOLOGICAL TREATMENTS FOR SPASTICITY
CLINICAL PATTERNS OF SPASTICITY
SUMMARY
REFERENCES
20 Spasticity in Spinal Cord Injury
INTRODUCTION
FACTORS CONTRIBUTING TO SPASTICITY
SPECIFIC ANATOMICAL PROBLEM AREAS RELATIVE TO SPASTICITY
A CLINICIAN’S GUIDE TO SEQUENTIAL INTERVENTION FOR SCI-ASSOCIATED SPASTICITY
APPROACH TO THE TREATMENT OF SPASTICITY IN SCI
ALTERNATIVE AND ADJUNCT THERAPIES FOR SPASTICITY IN SCI
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