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Clinical Evaluation and Management of Spasticity (Current by David A. Gelber, Douglas R. Jeffery

By David A. Gelber, Douglas R. Jeffery

David A. Gelber, MD, and Douglas R. Jeffery, MD, have assembled a much-needed choice of authoritative overview articles discussing the pathophysiology of power neurologic spasticity and detailing its frequently complicated scientific and surgical administration. Written via major specialists in neurology and rehabilitation, the booklet covers actual and occupational remedy, splinting and orthotics, electric stimulation, orthopedic interventions, nerve blocks, using botulinum toxin, and novel remedies corresponding to tizanidine, intrathecal medicinal drugs, and neurosurgical strategies. The participants additionally assessment coordinated methods to the therapy of spasticity and particular neurological ailments reminiscent of spinal twine harm, a number of sclerosis, stroke, cerebral palsy, and nerve-racking mind damage.

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If the swing overshoots the vertical, R2 is greater than 1. If the swing is interrupted before the limb reaches the vertical, R2 is less than 1, indicating spasticity (see Fig. 2). This measure has been used in several drug trials (23). The pendulum test is able to distinguish between spasticity in hemiparetic patients and rigidity in patients with PD (24). Although the pendulum test has some intuitive appeal, and correlates with the Ashworth scale (25,26), it requires technology not possessed by most clinicians (26).

Fisher, M. , Shahani, B. , and Young, R. R. (1979) Electrophysiologic analysis of the motor system after stroke: The flexor reflex. Arch. Phys. Med. Rehabil. 60, 7–11. 44 Good 47. , and Klemar, B. (1981) Standardisation of the electrical elicitation of the human flexor reflex. J. Neurol. Neurosurg. Psychiatry 44, 129–132. 48. , and Conrad, B. (1985) The flexor reflexinfluence of stimulus parameters on the reflex response. Electroencephalogr. Clin. Neurophysiol. 61, 287–298. 49. Bathien, N. and Bourdarias, H.

To complicate matters, some patients with the UMN syndrome exhibit features of rigidity. In fact, some muscles in the same limb may behave as though they are spastic, where others may appear rigid (2). Thus, some patients with spasticity do have increased muscle tone at rest. In many persons with hemiplegia, the upper limb is held flexed and adducted, and the lower limb is extended. With paraplegia or tetraplegia, the lower limbs are flexed and adducted, as are the upper limbs, if they are affected (2).

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