This text based course is a transcript of the live webinar titled, "Practical Clinical Outcome Measures for Upper Extremity Spasticity Treatment", presented by Vanessa Roberts, MS, OTR/L, CPAM.
>> Vanessa Roberts: Thank you for the invitation to come here today and talk about one of my favorite topics, which is spasticity. I find it absolutely fascinating and I have some really good information to share with you today.
Introduction
As you probably already know, spasticity can be a very disabling and complicated condition to treat. First off, how do we know that someone has spasticity? How can we differentiate spasticity versus high tone? Second, once we have identified those people with spasticity, how can we measure the severity, and how do we know that our interventions are making a difference? Thirdly, what are some options available for treatment?
Definition
Let’s begin with a technical definition. Spasticity can be defined as "a motor disorder, characterized by a velocity-dependent increase in tonic stretch reflex (muscle tone) with exaggerated tendon jerks resulting, from the hyperexcitability of the stretch reflex as one component of the upper motor neuron syndrome (UMNS), J.W. Lance, 1980. The most important word on this slide is velocity. I have some examples to show you later on in the presentation, but I would underline that word if you are following along on your handout.
When talking about upper motor neuron lesions, there are both positive and negative signs. A positive sign would be spasticity, whereas a negative sign would be weakness. This would be the difference in tone. Think of it as a continuum where low tone would be like a baby, and then high tone with spasticity at the opposite end. With someone who has not had a central nervous system insult, your tone should be somewhere right around the middle. When we are sleeping our tone goes down, but then we might experience an increase in tone as a defense mechanism.
