treatment of spasticity and use of gait analysis in rehabilitation...
TRANSCRIPT
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Treatment of spasticity and use of gait analysis in rehabilitation practice
Castagna Anna, MD Fondazione IRCCS Don Carlo Gnocchi IRCCS Santa Maria Nascente, Milano
Santa Maria Nascente Milano, EPR 17-18 November 2016
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Multidisciplinary, tailored, goal related approach
Patient
Neurologist
Bio ingeneer
Occupational therapist
Physiotherapist
Phychologist
PMR
Rehabilitation Team
Neuro- ortopaedic surgeon
Functional neuro-surgeon
ITB
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Treatment Goals
Improved Decreased
ROM Energy expenditure
Mobility Spasm frequency Gait Pain Orthotic fit Caregiver burden Positioning Ease of hygiene Cosmesis
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Therapy of spasticity (Ward,1995)
BACLOFEN IT Oral theraphy
FKT Motor learning
techniques Neuromodulation
Functional surgery Soft tissue treatment
(release, transfer,)
Demolitive surgery (tenotomy, bone surgery)
GENERAL
LOCAL
PERMANENT REVERSIBLE
Rizotomy Neurotomy
BoN
T-A
Ph
enol
ic b
lock
s
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Botulinum toxin associated with learning goals
ABILITY
Functional recovery and increased activity
Increase real life participation
MOTIVATION
Compliance
Intrinsic self efficacy
SKILLS To reduce impairment Increased ROM and
antagonist muscle power
Therapeutic window for learning process
BoNT causes every time a “boost” of plasticity
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Learning process
Neural processes of plasticity (neurophysiological parameters changing LT potentiation)
Biofeedback learning
Dramatic performance gain
Task oriented learning
Soft performance gain
Short term memory
long term memory
Skill acquisition
Largely automatic (real life)
CONSOLIDATION
Krakauer JW 2005
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SAFLo Movement analysis Laboratory
Simultaneous recording of movement to collect multiple data of full 3D total body analysis - Kinematics - Kinetics - EMG
16 channels 8 TV cameras optoelectronic system
2 TV cameras for video taping
2 dynamometric platforms (Kiesler)
LAMB protocol Rabuffetti, Crenna
(2004)
SMART system (BTS s.p.a., Milan, Italy)
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GAIT ANALYSIS: why, when, how, in patients affected by
spasticity
• Spasticity: post Stroke, CP, MS, TBI, genetic paraparesis
• Different goals depending on the rehabilitation programme involving the patient
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Why, when, how instrumented analysis
• Quantitative data are useful for functional diagnostic accuracy and decision making pre treatment and follow up (drugs, BoNT, Rehabilitation programmes)
• EMG mapping is useful for Botulinum Toxin targeting • Dynamic data are important before “weaken” muscles • Can be a repetitive quantitative measure of outcome • Mandatory in pitfalls analysis • Recommended before functional surgery (child and
adult), mandatory in US • Data collection in a experimental context for
transational research and scientific publications
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2015 EJPR
49 pts
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21 years old woman with L meningioma operation (4 months after)
•Loss of propulsion •Reduced speed •Reduced multilevel ROM
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HIP FLEXION ROTATION PS -PO
KNEE FLEX /EXT LEG INCLINATION
HEEL RISE
TRUNK CONTROL PS
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Therapy: positional biofeedback
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Post: Tstance Post: push off
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Kinematic and kinetic data on sagittal plane (Pre blu, Post black)
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THANK YOU FOR YOUR ATTENTION