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Spinal Cord Injury Spasticity Management Program

Physical and occupational therapists provide treatment and parent education for management of spasticity, including serial casting, splinting, range-of-motion exercises, strengthening exercises, functional skills training, orthotics consultation, and therapeutic electrical stimulation for spinal cord injury patients. Our goal is to develop a one- to two-year plan for the management of spasticity, in collaboration with therapists, the spinal cord injury patient, the family, the physician, and with other providers.

Spasticity Management Services for Spinal Cord Injury

The Spasticity Clinics at Mary Free Bed Rehabilitation Hospital were established to assess and manage spasticity in spinal cord injury pediatric and adult patients.

Services include:

Evaluation
At your initial visit, a receptionist will obtain registration, and confirm financial information obtained at time of referral. A nurse will guide you through an orientation, and perform an initial health assessment.You will be evaluated by a physician and a therapist who will share their impressions concerning management of your spasticity. In most cases, you will see the same team of specialists on return visits.

Oral Medication Option
A trial of oral medications, such as Baclofen, Zanaflex, Dantrium and Valium, alone or in combination, is initiated if the stretching regime has proven to be ineffective in minimizing spasticity. Liver function tests are ordered to ensure that liver toxicity is not a problem brought on by oral medication management.

Intrathecal Baclofen
The option of an intrathecal baclofen test dose may be offered to the patient and family. The test dose is administered at Mary Free Bed during a short stay admission.The day that the test dose is administered, the physiatrist, nurse and physical therapist are present to evaluate the effectiveness of the medication.They continually assess respiratory status, functional mobility, and spasticity. If the patient responds positively to the test dose, and is in agreement to proceed with intrathecal baclofen pump placement, then a referral is made to a neurosurgeon for consultation and placement. Once the pump is placed, it will be monitored on an ongoing basis for dose adjustments and refills at Mary Free Bed.

Orthotics
Orthoses may be used to support and/or brace joints to increase comfort and/or assist walking or other activity.The orthoses may also help to stretch muscles through prolonged positioning. An orthotist assists with fitting the orthoses, and any ongoing adjustments that may be needed.

Physical Therapy
The goal of therapy is to help individuals with spasticity to become as functional as possible.The physical therapist evaluates passive range of motion, functional skills, strength, and ability in order to provide the appropriate therapy to improve movement and mobility function. Part of the therapy may be to provide serial casting to help maintain range of motion.

Who Uses These Spasticity Management Services

Individuals who experience spasticity due to the following conditions:

Meet the Spasticity Treatment Team

The Spasticity Clinic team works closely with each patient’s (primary care/referral) physician. Spasticity management starts out conservatively with a home exercise program, which includes stretching and range of motion. We specialize in the care of patients with spasticity. A wide variety of specialists are available to best meet the needs of each individual patient.

Physiatrist

  • Physician specializing in physical rehabilitation medicine
  • Pediatric physiatrists also dually board certified in pediatric medicine
  • Manages the medical care and directs the rehabilitation team for each patient


Rehabilitation Nurse

  • Evaluates each patient, develops and oversees nursing care plan
  • Focuses on patient’s self-care, comfort and education
  • Provides ongoing intrathecal baclofen pump management under direction of rehabilitation physician; works in collaboration with MFB inpatient nursing team and rehabilitation physician for 24-hour coverage of intrathecal baclofen issues.


Orthotist

  • Available for evaluation with a physician referral
  • Years of experience in the utilization of orthoses for spasticity management
  • Provides expertise in customizing and fitting orthoses to assist with comfort and activity


Physical Therapist

  • Conducts PT consultations within clinic visits and during intrathecal baclofen test doses
  • Available for outpatient therapy evaluations and treatment upon physician referral, with depth and experience in management of spasticity
  • Evaluates patient’s balance, flexibility, endurance, strength and muscle function as these relate to mobility in hospital, home, school and community environments
  • Provides hands-on therapy to improve movement and mobility function
  • Provides serial casting for lower extremities
  • Evaluates need for equipment to manage mobility in home, school and community environments


Occupational Therapist

  • Available for outpatient therapy evaluations and treatment upon physician referral, with years of experience in management of spasticity
  • Evaluates and treats upper extremity movement and function, as well as areas of daily living such as eating/drinking, dressing, toileting, bathing, hygiene and cooking
  • Identifies need for special adaptive equipment to manage tasks of daily living and provides or customizes equipment to meet these needs
  • Provides splinting and serial casting for upper extremities


Contact the Spasticity Program and Clinic

PHONE
616.242.0395 or 800.790.8040

FAX REFERRALS
616.458.4874

DOWNLOAD
Outpatient Referral Form

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