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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.
Since publication of the first edition, Spasticity: Diagnosis and Management has been the defining reference and go-to source for physicians, therapists, and other healthcare providers who care for patients with spasticity. For this new updated edition, Dr. Brashear and a diverse team of specialists have come together to integrate new research, clinical trials, measurement tools, therapies, and other recent advances that reflect this evolving field. The book is organized into four sections, each of which covers a broad scope of material. The first is a general overview of spasticity and its effects on movement in patients. Other chapters cover epidemiology and ancillary findings commonly associated with spasticity. Part II details assessment tools and measurements, treatment goals, and how to aim for realistic outcomes. Part III outlines various treatment modalities, including heavily updated chapters on the use of botulinum toxin in the upper and lower extremities, guidance techniques for injections, intrathecal baclofen, neuromodulation, surgery, physical therapy, and more. The last section, which contains several new chapters, discusses evaluation of outcomes and management of patients with stroke, traumatic brain injury, spinal cord injuries, multiple sclerosis, cerebral palsy, and cancer, followed by chapters on spasticity management in long-term care facilities and economic considerations. This book remains the most comprehensive guide to diagnosis and management of spasticity in adults and children, and the revised second edition will continue to serve as an invaluable resource for professionals in any discipline who strive to provide quality care to spasticity patients. Key Features: Revised edition of the premier clinical reference on spasticity Incorporates the latest advances in assessment and treatment Contains six entirely new chapters highlighting key topics including Tardieu scale and other measurement tools, ultrasound guidance for botulinum toxin management, spasticity in special populations, emerging therapies, and economic impact More than 200 figures and 70 tables accompany the updated text
Spasticity: Diagnosis and Management is the first book solely dedicated to the diagnosis and treatment of spasticity. This pioneering work defines spasticity in the broad context of Upper Motor Neuron Syndrome and focuses not on a single component, but on the entire constellation of conditions that make up the UMNS and often lead to ......
With the contribution from more than one hundred CNS neurotrauma experts, this book provides a comprehensive and up-to-date account on the latest developments in the area of neurotrauma including biomarker studies, experimental models, diagnostic methods, and neurotherapeutic intervention strategies in brain injury research. It discusses neurotrauma mechanisms, biomarker discovery, and neurocognitive and neurobehavioral deficits. Also included are medical interventions and recent neurotherapeutics used in the area of brain injury that have been translated to the area of rehabilitation research. In addition, a section is devoted to models of milder CNS injury, including sports injuries.
Spasticity is a common symptom seen in many neurological conditions notably head injury, spinal cord injury, stroke, cerebral palsy and multiple sclerosis. It is also the dominant feature in a number of rarer conditions such as tropical and hereditary spastic paraparesis (HSP). The fact that it is relevant to many chronic neurological conditions and that the absence of multi-disciplinary input can result in progressive disability, ensures spasticity management is a prominent feature in the current National Service Framework (NSF) for long term neurological conditions. In the future more long-term care for such patients will be done in primary care and the community. It is therefore essential that a multi-disciplinary approach is used with successful liaison between secondary, primary and social care. Optimum management of spasticity is dependent on an understanding of its underlying physiology, an awareness of its natural history, an appreciation of the impact on the patient and a comprehensive approach to minimising that impact which is both multi-disciplinary and consistent over time. Regrettably, these essential requirements are rarely met and consequently, inadequately managed spasticity results in a range of painful and disabling sequelae, which, with the right approach, are, for the most part, preventable. Although there are several excellent publications looking at this area, none are a truly practical guide relevant to all members of the multi-disciplinary team involved in spasticity management. Anyone who has been involved in setting up a new service knows how difficult and how protracted a process this can be and if it has been done before, why reinvent it? The basis of this manual is to collect together the experience and knowledge of such a team who have worked in this area for 10 years now. It pulls together all areas including how to set up and develop a service as well as useful management strategies. On a practical note it includes complete copies of all of our patient information, assessment proformas, protocols for different interventions, nursing care plans and an integrated care pathway for outpatient spasticity management both as hard copy but also on CD-ROM to aid in reproduction. These protocols are of course specific to our team but could easily be adapted for use in other centres. We are not saying this is the 'right' or only way to run a spasticity service and there is certainly room for improvement, but we hope by sharing our experience we can help others to develop their own service thus improving management for all individuals with spasticity.
This is a thorough, practical reference and guide for all health professionals involved in the management of spasticity.
This open access book focuses on practical clinical problems that are frequently encountered in stroke rehabilitation. Consequences of diseases, e.g. impairments and activity limitations, are addressed in rehabilitation with the overall goal to reduce disability and promote participation. Based on the available best external evidence, clinical pathways are described for stroke rehabilitation bridging the gap between clinical evidence and clinical decision-making. The clinical pathways answer the questions which rehabilitation treatment options are beneficial to overcome specific impairment constellations and activity limitations and are well acceptable to stroke survivors, as well as when and in which settings to provide rehabilitation over the course of recovery post stroke. Each chapter starts with a description of the clinical problem encountered. This is followed by a systematic, but concise review of the evidence (RCTs, systematic reviews and meta-analyses) that is relevant for clinical decision-making, and comments on assessment, therapy (training, technology, medication), and the use of technical aids as appropriate. Based on these summaries, clinical algorithms / pathways are provided and the main clinical-decision situations are portrayed. The book is invaluable for all neurorehabilitation team members, clinicians, nurses, and therapists in neurology, physical medicine and rehabilitation, and related fields. It is a World Federation for NeuroRehabilitation (WFNR) educational initiative, bridging the gap between the rapidly expanding clinical research in stroke rehabilitation and clinical practice across societies and continents. It can be used for both clinical decision-making for individuals and as well as clinical background knowledge for stroke rehabilitation service development initiatives.
Many of the existing books focusing on the orthopedic management of patients with cerebral palsy encompass only care for the young patient, but this practical text reviews and delineates orthopedic care for patients with cerebral palsy throughout the lifespan. Readers will find a discussion of both non-operative and operative orthopedic management across all ages and functional levels. The text presents a general overview of cerebral palsy, evaluation of patients with cerebral palsy, and procedures commonly used to treat various orthopedic conditions in patients with cerebral palsy. Spasticity management and gait evaluation are likewise highlighted, and surgical chapters cover techniques for the hip, knee, foot and ankle, and spine. It also incorporates chapters focused on issues related to the rehabilitation of patients with cerebral palsy, including bracing, orthotics and other durable medical equipment, physical and occupational therapy, pain management, and adaptive activities and sports, which aim to improve the overall quality of life for patients through the lifespan. Finally, there is a chapter focused on the care transition from childhood to adulthood, an area of importance often neglected in current texts covering patients with cerebral palsy. Whether in the operating room, multi-specialty clinic or private office, Orthopedic Care of Patients with Cerebral Palsy will be a go-to resource for orthopedists, pediatricians and all medical professionals caring for this population.
"Every year between 250 000 and 500 000 people suffer a spinal cord injury, with road traffic crashes, falls and violence as the three leading causes. People with spinal cord injury are two to five times more likely to die prematurely. They also have lower rates of school enrollment and economic participation than people without such injuries. Spinal cord injury has costly consequences for the individual and society, but it is preventable, survivable and need not preclude good health and social inclusion. Ensuring an adequate medical and rehabilitation response, followed by supportive services and accessible environments, can help minimize the disruption to people with spinal cord injury and their families. The aims of International perspectives on spinal cord injury are to: ---assemble and summarize information on spinal cord injury, in particular the epidemiology, services, interventions and policies that are relevant, together with the lived experience of people with spinal cord injury; ---make recommendations for actions based on this evidence that are consistent with the aspirations for people with disabilities as expressed in the Convention on the Rights of Persons with Disabilities.