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A-1158 Non-Surgical Treatment Options for Spasticity
Fin Biering-Sørensen, Copenhagen, Denmark
Friday, June 15, 2018 · 9:01 a.m. · 16m 04s
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so i'll spinal cord injuries effect ionised are most well thank you
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okay happy not to talk about the non surgical treatment options for specificity
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okay just for us to see you this is the picture from yeah consumer
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hancock and i think that really shows what many of the problems are not in
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the upper extremity but also in the lower extremes it's yours you can see
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aspect is ten so we in redefined as a disorder since
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remote to control resulting from another motion urine deletion
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presenting is intimate not sustained involuntary a heck yeah activation almost
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and the basis for this is not yet completely understood
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so we know that's that's the city is caused by adaptation of changes
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in the spine make work and that's the still of course to the legion of that is in the mood to possibly is
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it does mean clinic in it may imply enhanced tendon reflexes it may also not
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extended reflex sounds cool news increased muscle tone and increased fixer reflexes but
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it is important to know it's maybe it's not always like that
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and is also very important to be or that changes in mechanic uh properties
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of the muscles i don't include contractors on that and come and
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clinical it's very easy to mistake it's and it's important to be aware
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of what is actually most most low activity in port au contractors
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how frequent this this and uh as you can see from this year stroke
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is a very prevalent condition will and a c. i. in this aspect is the base
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frequent spinal cord injuries that people is of specificity is most prevalent in super posted
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and the province of disabling discrepancy is uh this past is it is in
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spinal cord injury and in most obscure which is the most prevalent
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so i assessment before you do something whatever it's surgery all other things you do
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we usually say it's good to use the i. c. f. in the sense you
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know what are the problems but functional bias pain stiffness bastions locking up joins
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and of course what is the most important for the consumer the patient that's the activity
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how do i get around my all my eighty l. functions that's really what what
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ah so that each person so that's what you have to go into
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and of course generally speaking participation not get around what about my work children et cetera et cetera
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so all these facts us of course has an implication on
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the porch allies life so that's the important thing really
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to be a way out because that's it at the end what the country more the patient want to increase
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so when you assess your patience you should on colour
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the various manifestations and the limitations for the patient and of course
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in accordance with the damage three dimensions we mentioned before
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and this also make this on the same time easier for you as
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clinicians to find the relevant goals to deal with the patient consumer
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yeah but we should also be aware that they are possible pasta effect of specificity
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and the sometimes you have to balance that out and to for instance you
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may have extensive spaces in the lakes that no help stanton transfer
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and therefore of course you have to see that anticipates a relieving it
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if that's a better thing to have instead of relieving us and subjective symptoms
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coming so the objective side how do we assess usually there's
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no really cool standard in this but the most
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common used to use a modified or the not modified
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aspects katie and the pain scale fall specimen frequency
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you may also use has a range of motion actually range of motion
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if this low instruments is gates distance and speed of course a deal measures
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maybe very important as i said before because what is important thing for that
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patient and consumer that's really the activities actually leaving what kind it too
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cool attainment scaling goes goal is also good to see what is actually
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the cools the paste wants that and to evaluate the fact that she men in relation
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to the patients schools the treatment are re may be used very also you had
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this year pastes and others who can right into the diary to
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actually keep the based information for the treatment in the continuation
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it is very important when they talk about specificity
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to be aware op that many it's different sings in
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the places live in complications can actually enhance distaste
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so before you treat this best to see you need really to be sure the
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space this is is not course by something you should take care of first
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and this is at least which ah things complications which may imply increased specificity
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and you can see it's a very long list and the important thing
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here is actually also to be aware that some trucks for instance
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antidepressant can increase busty city and you should be aware that maybe
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before you start doing a lot of other kinds of treatment
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but as you say we usually say when you have increased busy bee who all the way around the patient to see
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many times raises is just because i had a urinary tract infection that increased specificity
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show
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if we should take the algorithm you describe the patients problem penalise the
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courses and remove potential worsens stimuli as i just mentioned to you
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and then formulate your treatment goals and of course i
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should be specific measurable achievable relevant in time but
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and then you may distinguish what we're talking about it's a focal multi vocal regional a journalist
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because that may also imply on the kind of treatment you start so
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if possible is terribly occupations are self training guide itself reputation of
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course should be done that's easy saying if at all possible
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then for the focal multi vocal you may use
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pulling which line interaction which comes later on
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for the reno journalist or or medication
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and then of course you have all the other more specific issues and
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some of these will be covered in the next two presentations coming up
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so looking on
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the non pharmacological interventions for space to see it will go on
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the meta analysis studies et cetera review studies and nice
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there's a moderated instead electra your muscular stimulation and acupuncture as
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an adjunct therapy to conventional routine care prisons falling stock
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so there is something you may use here
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unfortunately if we look on nearly everything else
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only low quality begins for you chasing programs talking spotty specificity
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and this you can see there's a lot depends also on the kind of neurological
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condition you have the stroking choose movement therapy
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stretching dynamic both painting occupation zippy
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extra corporal shop way therapy transcribing a direct current stimulation
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extermination and transcription is like is to listen for all the neurological conditions physical activity programs
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right it is your mike nice to mason like hybrid surgeons there be stretching so
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and even for those they've it ends up inclusion in conclusion
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so it's not much out there to be honest stretching in particular has been used for many is
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and there's been a lot of course see high quality evidence that's strange
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to not have clinical importance effects on the joint mobility people
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will hold out your logical conditions you perform this then seven months
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so i picked up stretch perform peers longer and so much has not been investigate but this is just to tell you
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that actually it depends is not very high on the other hand in clinical praxis we
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have also have to be honest to each other that many hours new from
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you can use sometimes he each you may use cool you may use a
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lot of the things to which has not really have conclusive evidence but
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all these kinds of treatments it's only short lasting if he does anything
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it would be a couple of hours or something like that
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okay so that may not have been the very positive results so far so
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we go to a may december about that the trucks we get
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two studies have shown significant effect up exactly go back from using specificity
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and there have been studies comparing descended into the placebo sure significant
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effect on improving ask or score but not a deal performances
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fall cap unseen twenty dean tiresome pam how much how over back
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off in the results do not provide evidence was significant
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effectiveness
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there is insufficient evidence to assist clinicians in rational approach princess plastic tree
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it is it's probably most of you know it is trials and are
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and is always the balance what is the effect and what is the worst events for the patients
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so anyway we have to be aware of the side effects citations personnel policy
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and the piano impairment of work important as we talk about so precautions price
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initiating the treatment yeah which we should be max of patients goes
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surely effect cover the whole day or only the night with the patients function
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they would be threatened by reducing this basis as we talk about
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can the patient fallen escalating schedule
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start logos
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you've increased only building for the knife in the infield increase those
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continue to increase want to target is reached all
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the maximum tolerate those what is used usually is to start about fifteen sixteen eighteen
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seventeen controlling but it's the usual saying most to the trucks may be combined
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and use captain team if you have your pelvic pain on the same time because that's also good for new headache pain
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or not go through this year just to remind you for the
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into this p. i. insidious beans you only medications which can be used when the patient is pregnant
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so that's actually important thing the other thing is that if you used actually in
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symptomatic appetite is is important that you follow we'll see uh the prince times every three months
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and for for the different products yeah where that to send a team is not used in pediatrics we
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have not the data and then the side effects we talked about that seek it's the um situation
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is very common and then before the task pam addiction intolerance you should be aware
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so i cannot base is very often time up in seven reviews
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i'm not sure i agree will all the way the reviews have been done but um
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the chorus this most of the reviews they actually found evidence that t. h. c.
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n. t. s. c. c. p. d. products may reduce by c. c.
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oh concluded that into your favourite counterparts to treat spaces is based on the results of individual
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studies entrance to watch significant effects but remember at least in denmark illegals maybe different
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different countries you said you're not allowed to drive a car if you take t. h.
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c. so that's a big big problem if you uh want to do that
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finally part of informs the second c. you do not talk about do you use it
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does not effect of a more have onset acceptable side effects of problem medication
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and they for most our patience this is really fantastic treatment so we'd have to do high
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concentration of part of him in this mind service but of flute and this adverse events
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so shown to grease paint improve sleep a deal clapton power problem and decrease kick your time
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it is even found effective
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for treating other extreme to have it on yeah
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and there was substantial level for events that into secure parking thing is if it's in reducing specificity
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and the average closing may actually increase from baseline him to follow
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as you can see here several times but still very effective
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complications of course there are and that's it for the pomp and the casino malfunction
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but um will increase experience putting in the palms of
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the less the less um complications to see
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just to show you we made a study actually here in denmark and you
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can see that's actually what people they did use factor finches and jean
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into types of beans and what i'm controlling black fin
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palms and the other treatments is here given
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include physical circuit between them talk sign kind of peace and acupuncture
Conference Program
A-1158 Non-Surgical Treatment Options for Spasticity
Fin Biering-Sørensen, Copenhagen, Denmark
June 15, 2018 · 9:01 a.m.
A-1158 Non-Surgical Treatment Options for Spasticity - Q&A
June 15, 2018 · 9:18 a.m.
A-1159 Use of Botulinum Toxin in Decision-Making and Applications to Selective Neurectomy
Caroline LeClercq, Paris, France
June 15, 2018 · 9:20 a.m.
A-1159 Use of Botulinum Toxin in Decision-Making and Applications to Selective Neurectomy - Q&A
June 15, 2018 · 9:40 a.m.
A-1160 Surgical Treatment Algorithms in Spasticity
Jan Fridén, Nottwil, Switzerland
June 15, 2018 · 9:44 a.m.
158 views
