Rehab medicine physicians at Sister Kenny Rehabilitation Institute, called physiatrists,
are experts in treating spasticity and prescribing therapies and equipment that
may be beneficial after spasticity is controlled.
Spasticity is involuntary, increased muscle tone that occurs when the brain communication
with the spinal cord is partially disrupted due to illness or injury in the nervous
system. The brain can no longer send signals that inhibit or balance muscle tone,
so it is "turned on at high volume" and is easily stimulated by movement
or irritation. It can develop immediately after an injury or develop after several
weeks. It can sometimes be a barrier to voluntary movement or cause pain or difficulty
with self care, safety and mobility.
Spasticity can often be controlled with oral medications such as Baclofen (Lioresal),
Zanaflex, Valium and other medications. When these medications are insufficient
or cause side effects like sedation, confusion, liver toxicity or excessive weakness,
other methods can be used. Also, during times of decreased spasticity, therapists
and patients can work to increase range of motion and possibly strengthen muscles
previously overwhelmed by the spastic muscles.
Injecting the muscle at the nerve muscle junction with small amounts of Botox
temporarily decreases signals to the muscle that cause spasticity. Physicians
at Sister Kenny Rehabilitation Institute do this procedure in the clinic and effects
can last about 8 to twelve weeks. This technique is used when spasticity affects
primarily one limb or decreases movement of one joint, such as spastic wrist and
finger flexor muscles that cause fisting and decreased hand use in stroke patients.
For people with severe spasticity who cannot get relief from pills or have undesirable
side effects of medication, physicians will implant a pump that delivers antispasticity
medication 24 hours a day. The medication travels directly to the spinal cord
via the fluid surrounding the cord. After a successful test dose is done, a neurosurgeon
or anesthesiologist implants the pump (made by Medtronic) under the skin. A tiny
tube or catheter is inserted under the skin and goes into the spinal canal below
the end of the spinal cord. This allows the medication to flow up the fluid that
normally surrounds the spinal cord and target the cells that cause spasticity,
decreasing their action. By the time the fluid gets to the brain, most of the
medication (delivered in microscopic amounts) is used up; thus the patient does
not usually have side effects that they may encounter with taking pills.
Like a pacemaker, the pump can be reprogrammed by an external device, and is filled
by a small needle every four to 12 weeks at the Sister Kenny clinic. The dose
can be changed in microgram amounts and can be adjusted for different times of
the day, allowing more at night and less during the day. Patients can usually
stop all or most of their oral antispasticity drugs and often experience decreased
pain due to spasm.
Referral
A referral from a physician is needed before you can be seen in the clinic. Your
physician can make a referral by fax at 612-863-8942 or phone at 612-863-8947.
Sister Kenny Rehabilitation Institute
800 E. 28th St.
Minneapolis, MN 55407
612-863-4200 or toll free 866-880-3550
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