Id 87
Topic Spasticity
Main Speaker Karen Ethans Canada
Co Speakers Cindy Ivanhoe Canada, Colleen O’Connell Canada
Attendees 50
Extra Fees

This workshop will be presented by 3 experienced Physiatrists, each with decades of experience treating spasticity in people of various etiologies. Focus will be of the lower limb as it is more neglected typically in international discussions. 3-4 case reports will be discussed, with presentation and treatment needs changing as the patient course evolves. Typically, discussions around lower limb spasticity are focused on chemodenervation treatment in the distal lower limb for stroke, segmental spasticity treatment with intrathecal baclofen for upper motor neuron diseases such as spinal cord injury or multiple sclerosis, or generalized spasticity therapy with oral agents. It is rare to have workshops or presentations addressing the patient with multifocal spasticity of lower limbs, including the proximal lower limb, in the populations other than just stroke. Discussion will be interactive, encouraging participation from the audience members, as to what treatments to consider and why. Assessment will be discussed, including goals of therapy, not just ambulation but other goals such as dressing, catheterizing, hygiene etc, with measurable targets such as Tardieu Scale for the hips, and Modified Carer Burden Scale. Use of botulinum toxin will be discussed especially in the proximal lower limb muscles, where it is rarely discussed at such meetings as there has been little research in this area. Consideration as to why to target muscles such as tensor fascia lata, rectus femoris, and sartorius are examples and what to be cautious of in these areas. Avoiding pitfalls in the ankle and foot will be discussed, including recognizing tenodesis and not over diagnosing spasticity of extensor hallicus longus and underdiagnosing spasticity of flexor digitorum longus. Biomechanics will be touched on, with recognition of all ankle inverters when treating inversion, and why the ankle is so unstable into inversion when plantarflexion tone is present. Phenol neurolysis will be discussed in some detail, including the history, and how to pick targets for phenol neurolysis, including motor nerves, motor branches of nerves, and motor points, with practical explanations and video demonstrations of use and how to incorporate its use in people with multifocal lower limb spasticity for botulinum toxin sparing of large doses, or in those intolerant of botulinum toxin, with cases presented. Bracing of the lower limb will be considered, and cases will also include patients that have gone on to surgical intervention and why, as well as intrathecal pump management. Using multimodal therapies to address multifocal spasticity of the lower limbs in various populations with upper motor neuron disorder is essential for the physiatrist specializing in spasticity management, and each tool in the toolbox needs to be individualized for each patient.