Abstract
Spasticity is a common movement disorder that arises from trauma or disease affecting
the central nervous system. Untreated spasticity can result in limitations in completing
activities of daily living, painful limb contractures, and other conditions associated
with loss of mobility. In the long-term care setting, this treatable condition is
prevalent, yet often unrecognized likely because of a lack of spasticity-trained practitioners.
A recently published spasticity referral tool holds promise for addressing the underdiagnosis
of spasticity in the long-term care population. The Minimum Data Set (MDS) would be
an ideal mechanism for increasing the diagnosis and treatment of spasticity because
it is a government-directed comprehensive screening tool that informs care plans for
all residents residing in federally funded long-term care facilities. The MDS could
easily integrate the published referral assessment to record the presence of spastic
postures and muscle rigidity. We propose expanding the MDS to include 3 questions
related to spasticity to improve the recognition and treatment of this prevalent and
treatable condition.
Keywords
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References
- Rehabilitation medicine: 3. Management of adult spasticity.CMAJ. 2003; 169: 1173-1179
- Complications following spinal cord injury: Occurrence and risk factors in a longitudinal study during and after inpatient rehabilitation.J Rehabil Med. 2007; 39: 393-398
- Prevalence, impact and treatment of spasticity in nursing home patients with central nervous system disorders: A cross-sectional study.Disabil Rehabil. 2017; 39: 363-371
- Spasticity in adults living in a developmental center.Arch Phys Med Rehabil. 2003; 84: 1808-1812
- Prevalence of spasticity in nursing home residents.J Am Med Dir Assoc Press. 2020; 21: 1157-1160
- Effect of early rehabilitation on spasticity, activities of daily living and motor function in patients with hemiplegia after stroke.Chin J Rehabil Med. 2006; 21: 494-496
- A clinical overview of treatment decisions in the management of spasticity.Muscle Nerve Suppl. 1997; 20: S14-S20
- Pathophysiology of impairment in patients with spasticity and use of stretch as a treatment of spastic hypertonia.Phys Med Rehabil Clin N Am. 2001; 12: 747-768
- Baclofen effect on quadriceps strength in multiple sclerosis.Arch Phys Med Rehabil. 1992; 73: 237-240
- Baclofen (Lioresal) in the long term management of spasticity.Med J Aust. 1976; 1: 654-657
- Efficacy and safety of oral baclofen in the management of spasticity: A rationale for intrathecal baclofen.J Rehabil Med. 2017; 49: 193-203
- Psychological and emotional effects of the use of oral baclofen: A preliminary study.Paraplegia. 1994; 32: 349-353
- A double–blind, placebo–controlled trial of tizanidine in the treatment of spasticity caused by multiple sclerosis.Neurology. 1994; 44: S70-S78
- Tizanidine treatment of spasticity: A meta-analysis of controlled, double-blind, comparative studies with baclofen and diazepam.Adv Ther. 1998; 15: 241-251
- The efficacy of diazepam in enhancing motor function in children with spastic cerebral palsy.J Trop Pediatr. 2005; 51: 109-113
- Spasticity: Revisiting the role and the individual value of several pharmacological treatments.NeuroRehabilitation. 2010; 27: 193-200
- Neurological rehabilitation and the management of spasticity.Med (United Kingdom). 2016; 40: 513-517
- Gabapentin for the treatment of spasticity in patients with spinal cord injury.Spinal Cord. 1997; 35: 686-689
- Gabapentin for relief of spasticity associate with multiple sclerosis.Am J Phys Med Rehabil. 1998; 77: 451-454
- Spasticity management, part 2: Choosing the right medication to suit the individual.Br J Neurosci Nurs. 2009; 5: 419-424
- Focal spasticity therapy with botulinum toxin: Effects on function, activities of daily living and pain in 100 adult patients.J Rehabil Med. 2006; 38: 166-171
- Botulinum toxin: Mechanisms of action and clinical use in spasticity.J Rehabil Med. 2003; 41(Suppl): 56-59
- Impact of botulinum toxin type A on disability and carer burden due to arm spasticity after stroke: A randomised double blind placebo controlled trial.J Neurol Neurosurg Psychiatry. 2000; 69: 217-221
- Intrathecal baclofen pump for spasticity: An evidence-based analysis.Ont Health Technol Assess Ser. 2005; 5: 1-93
- Long-term effect (more than five years) of intrathecal baclofen on impairment, disability, and quality of life in patients with severe spasticity of spinal origin.J Neurol Neurosurg Psychiatry. 2004; 75: 1553-1557
- Voiding dysfunction in patients with spastic paraplegia: Urodynamic evaluation and response to continuous intrathecal baclofen.Neurourol Urodyn. 1993; 12: 163-170
- Effect of intrathecal baclofen delivered by an implanted programmable pump on health related quality of life in patients with severe spasticity.J Neurol Neurosurg Psychiatry. 1997; 63: 204-209
- Hyperthermia, rhabdomyolysis, and disseminated intravascular coagulation associated with baclofen pump catheter failure.Arch Phys Med Rehabil. 1998; 79: 353-356
- Clinical and functional outcome after alcohol neurolysis of the tibial nerve for ankle-foot spasticity.Brain Inj. 2001; 15: 733-739
- Alcohol neurolysis of the sciatic nerve in the treatment of hemiplegic knee flexor spasticity: Clinical outcomes.Arch Phys Med Rehabil. 2000; 81: 1432-1435
- Spasticity and hyperselective neurectomy in the upper limb.Hand Surg Rehabil. 2017; 36: 391-401
- The role of neurectomy in the management of spasticity of the upper limb.EFORT Open Rev. 2017; 2: 469-473
- Pronator teres selective neurectomy in children with cerebral palsy.J Hand Surg Eur Vol. 2018; 43: 879-884
- Long-term functional benefits of selective dorsal rhizotomy for spastic cerebral palsy: Clinical article.J Neurosurg Pediatr. 2013; 12: 142-150
- Long-term outcome and adverse effects of selective dorsal rhizotomy in children with cerebral palsy: A systematic review.Dev Med Child Neurol. 2011; 53: 490-498
- Spasticity after spinal cord injury: An evidence-based review of current interventions.Top Spinal Cord Inj Rehabil. 2007; 13: 81-97
- Clinical assessment and management of spasticity: A review.Acta Neurol Scand. 2010; 122: 62-66
- The National Nursing Home Survey: 2004 overview.Vital Health Stat. 2009; 13: 1-155
- The prevalence of spasticity in veterans living in a long-term care facility.Int J Neurol Neurother. 2016; 3: 56
- A simple bedside screening tool for spasticity referral.Clin Interv Aging Press. 2020; 15: 655-662
- Epidemiological, humanistic, and economic burden of illness of lower limb spasticity in adults: A systematic review.Neuropsychiatr Dis Treat. 2014; 11: 111-122
- Injectable neuromuscular blockade in the treatment of spasticity and movement disorders.J Child Neurol. 2003; 18: S50-S66
- Spasticity diagnosis and treatment in the united states-a priority for our aging population.Int J Neurorehabil. 2016; 3: 216
- Reducing waits and delays in the referral process.Fam Pract Manag. 2002; 9: 39-42
- The current state and needs of North American movement disorders fellowship programs.Parkinsons Dis. 2013; 2013: 1-7
- Overview of significant changes in the Minimum Data Set for nursing homes version 3.0.J Am Med Dir Assoc. 2012; 13: 595-601
- Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, Version 1.17.1.2019
- The nursing home minimum data set assessment instrument: Manifest functions and unintended consequences: Past, present, and future.Gerontologist. 2009; 49: 727-735
- Long-term care providers and services users in the United States: data from the National Study of Long-Term Care Providers, 2013-2014.Vital Heal Stat Ser 3. Anal Epidemiol Stud. 2016; 38: 1-105
Article info
Publication history
Published online: September 03, 2020
Footnotes
This research did not receive any funding from agencies in the public, commercial, or not-for-profit sectors.
Vanderbilt University Medical Center receives income from grants or contracts with Allergan, Ipsen, Medtronic, Merz, Pharma Two B, and Voyager for research or educational programs led by David Charles. David Charles receives income from Alliance for Patient Access, Revance, and USWorldMeds for consulting services. There are no conflicts of interest for Miranda Tomaras, Sandra Simmons, Jack Schnelle, and Mallory Hacker.
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© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
