presented by Stephen Page
Spasticity is frequently exhibited after stroke, spinal cord injury, traumatic brain injury, and a number of other upper motor neuron disorders. Yet, despite its high prevalence and widely appreciated impact on valued activities, spasticity remains one of the most difficult to treat and poorly-understood neurological impairments. In this course, you will learn evidence-based spasticity assessment and treatment strategies, as well as why spasticity occurs, how it differs from other impairments, and when in the recovery trajectory spasticity typically occurs.
Dr. Page’s team develops and tests approaches that increase function and independence after stroke and other neurologic diseases. He has held uninterrupted extramural funding to support his rehabilitative trials for over 15 years, and has produced many "firsts" in neurorehabilitation, developing and showing efficacy of mental practice, portable robotics, modified constraint-induced therapy, functional electrical stimulation, brain stimulation in moderately impaired individuals, and several other innovative strategies in people with acquired brain injuries. This includes eight NIH grants and five grants from the American Heart Association, as well as funding from multiple private organizations and subcontracts. He has also published well over 100 peer-reviewed articles, and has served as guest issue editor for 14 special issues of rehabilitative and neurological journals since 2001, including The Archives of Physical Medicine and Rehabilitation, The American Journal of Physical Medicine and Rehabilitation, and The Journal of Head Trauma Rehabilitation. He is a fellow of the American Heart Association, The American Congress of Rehabilitation Medicine, and The American Occupational Therapy Association, and a standing panel member on NIH's Function, Integration, and Rehabilitation Sciences Panel. While "translation" is a common buzzword in academic circles, very few clinician scientists make efforts to actually speak regularly with nonscientist audiences (such as clinicians and patients) about their findings. To accomplish such translation, Dr. Page has organized and chaired eight regional, national, and international neurorehabilitation conferences, co-chaired the 2003 and 2004 international, joint meetings of the American Society of Neurorehabilitation / the American Congress of Rehabilitation Medicine and served on the Board of Directors for these organizations. Locally, he created and co-directed the Ohio Neurorehabilitation Academy, which brings in national speakers to provide all-day, "hands-on" neurorehabilitation education to rehabilitation clinicians from across his region. He also takes great joy in providing lunch and learns to area clinicians, and outside of his region co-develops and co-implements the field's only stroke certification for physical and occupational therapists. This seminar-based program–called the "Certified Stroke Rehabilitation Specialist" (CSRS)–is another way that he translates scientific information to clinicians. You can learn more about this opportunity at www.strokecertification.com. Finally, he has mentored well over 60 students, with almost all of them at least publishing a paper and/or presenting the results of their work at a professional meeting. His mentees have won multiple awards for their work, including four "Outstanding Poster" Awards in the past two years alone at the annual international meeting of the American Congress of Rehabilitation Medicine, and four capstone awards, won by his mentees in engineering over the past four consecutive years. In 2008 Dr. Page was co-awarded the "Outstanding Mentor" Award from Xavier University.
This chapter will provide an operational definition of spasticity and briefly discuss its prevalence and functional effects, the joints where it is most likely to be exhibited, and the underlying neurophysiology.
This chapter will introduce the learner to the Modified Ashworth Scale, explaining its rationale, measurement features, what it is measuring, and use in order to ascertain spasticity in the lower extremity.
This chapter will identify and describe the rationale and application of commonly used medical and therapy approaches to manage LE spasticity. Emphasis will be placed on the rationale and application of treatments and techniques that can be applied by therapists.