Weeks to months after a traumatic injury or stroke, patients may develop a variety of complications, including spasticity.
Asare Christian, MD, MPH, discusses spasticity management after stroke and when to refer to the specialists at Good Shepherd Rehabilitation Network.
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Spasticity Management After Stroke
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Learn more about Asare Christian, MD
Asare Christian, MD, MPH
Asare B. Christian, MD, MPH, a physical medicine and rehabilitation physician, has joined the staff of Good Shepherd Rehabilitation Network. Dr. Christian is seeing outpatients at the Spine & Joint Center at the Good Shepherd Health & Technology Center in Allentown and at other Good Shepherd sites. He specializes in musculoskeletal issues (including joint pain, low back pain and arthritis), stroke, non-interventional pain management, spasticity and dystonia management.Learn more about Asare Christian, MD
Transcription:
Melanie Cole (Host): Weeks to months after a traumatic injury or stroke, patients may develop a variety of complications, including spasticity. Our topic today is spasticity management after stroke, and my guest is Dr. Asare Christian. He's the Associate Outpatient Medical Director at Good Shepherd Rehabilitation Network. Dr. Christian, welcome to the show. Explain a little bit about what happens in the weeks to months following a stroke.
Dr. Asare Christian (Guest): All right. If an individual has a stroke, multiple things can happen. One of the things that most individuals experience with stroke are motor deficits, meaning weakness, as well as some cognitive issues. They can also have problems with their bowel, bladder. A whole lot of issues that the majority of individuals have problems with is their muscles following a stroke event.
Melanie: So then, what would be the cause of that spasticity? Speak a little bit about the etiology of it.
Dr. Christian: Spasticity is caused by something we call an upper motor neuron lesion. Basically, in the absence of a stroke, you have all of these connections from your brain into your muscles that allow your muscles to contract the right way. For example, if you’re lifting something up with your arms, your biceps will activate, your triceps will relax, and all of this coordination is taken care of by the brain. We have contraction and co-contraction of different muscles, and your brain puts breaks on all of this muscle activation. When you have a stroke, what happens is that we have a lesion or something that impacts the ability of the brain to control those types of movements. Individuals can develop spasticity where there is now stiffness, or there is one muscle contracting more than the other. This can lead to pain, and this can lead to multiple complications.
Melanie: Speak about some of those complications.
Dr. Christian: One that I mentioned, is pain. Pain can be significant for patients with spasticity. We can also have problems with skin breakdown because if you have a constant state of contraction, skin can break down. It’s also hard for individuals to do basic ADLs or self-care. If your hand is contracted, it might be very difficult for you to put on your clothing. It might be very difficult for you to use your hand. Subsequently, if we don’t treat this, this can also lead to contractures where there is a permanent shortening of the tendons. This may require surgery or other complications arise as just outlined.
Melanie: Dr. Christian, tell us about your multidisciplinary approach to treat spasticity, and what type of providers are involved? Is this a very cohesive situation to work with?
Dr. Christian: Yeah, so spasticity management is as you mentioned, a comprehensive approach. The paradigm for treatment includes physical therapy, stretching, medications, injections with Botox. We can also do Phenol injections, so there is a huge spectrum based on the patient’s need. One of the things we focus on in our practice is trying to provide value to the patient. What we do is what is the spasticity preventing the patient from doing? What are the patient’s goals? What are their functional needs? We sit down with the patient; we talk to the team, the therapist, as well as the rest of the patient’s family, to try and create a goal and subsequently, we’ll come up with a plan to address and achieve that goal for the patient.
Melanie: What are some of the non-surgical treatments that are available? If surgery is required in severe cases, get into that a little bit, but start with some of the non-invasive treatments.
Dr. Christian: The majority of individuals as you pointed out, would not require surgery for spasticity, especially for stroke. Treatment starts with physical therapy, stretching. Heat tends to work very well for stiff muscle. Modalities of heat, ultrasound, TENS units, all of those can play a role in treatment. We can also use medications. There are multiple medications that we can use for patients. And then, if all of that does not work for the patient – or based on the type of spasticity – when we talk about spasticity, we have focalized where there is a specific area of the body that’s affected, or you can have generalized spasticity where it’s all over the place. That becomes hard to treat with botulin toxin. Based on the type of spasticity that individuals have, we can use this non-surgical approach – i.e., physical therapy, occupational therapy, medications, and then potentially, Botox injections as needed.
Melanie: Speak a little bit about the rehabilitation technology which can provide passive or assisted movement help for people that suffer from this.
Dr. Christian: Yeah, so there are multiple technologies out there for rehabilitation for individuals with spasticity. The ones that we know that work very well actually tends to be very simple, just range of motion. There are multiple types of equipment that we have at our disposal to help us with that. We actually have Exoskeletons, specifically, at Good Shepherd, to help with mobility and to improve muscle strength and lengthening. We also have functional FES; there are multiple bikes. We have zero-gravity therapy modalities and multiple technologists here at our disposal to address the specific needs of our patients.
Melanie: Dr. Christian, tell us about your team at Good Shepherd Rehabilitation Network.
Dr. Christian: We have an excellent team of clinicians here at Good Shepherd. Good Shepherd has been around for almost 100 years, so we have had a lot of experience dealing with individuals with functional impairment and disability. Our approach here is a comprehensive approach. We want patients and families to achieve their goals. Everybody’s goal will be different, so irrespective of what the patient is coming from, we try to set realistic goals for the patient. The team here, as I mentioned earlier, consists of our physical therapists. We also have neuropsychologists; we have speech pathologists. We have assistive technology individuals and other staff who all work with the team with the goal of trying to improve function for the patient.
Melanie: Now, wrap it up for us. Tell other providers what you want them to know about spasticity management and when you feel it’s appropriate for them to refer to the specialists at Good Shepherd Rehabilitation Network.
Dr. Christian: Yeah, so spasticity can affect a lot of patients with stroke. A lot of times, it does go unrecognized or untreated. Spasticity can lead to pain. It can lead to complications of skin breakdown; it can lead to contractures. It can also lead to increased energy expenditure. As it turns out, if you have spasticity, it actually requires a lot of energy to move your muscles, so what we’d like for providers and other clinicians to understand is that we have a comprehensive approach to spasticity management. We have physical therapists, occupational therapists. We have experience and expertise in the management of spasticity with botulin toxin, with baclofen pumps, and potentially, if the patient does require further management, we have networks of other physicians or surgeons that we can refer to. Our goal here is a comprehensive approach to care, so if an individual gets here, we will make sure that all of their needs are addressed in terms function as it relates to spasticity.
Melanie: Thank you so much. What great information, Doctor. Thank you for joining us today. This is Be Well, the podcast from the rehabilitation experts at Good Shepherd Rehabilitation Network. For more information on resources available at Good Shepherd Rehabilitation Network, please visit GoodShepherdRehab.org, that's GoodShepherdRehab.org. This is Melanie Cole. Thanks so much, for listening.
Melanie Cole (Host): Weeks to months after a traumatic injury or stroke, patients may develop a variety of complications, including spasticity. Our topic today is spasticity management after stroke, and my guest is Dr. Asare Christian. He's the Associate Outpatient Medical Director at Good Shepherd Rehabilitation Network. Dr. Christian, welcome to the show. Explain a little bit about what happens in the weeks to months following a stroke.
Dr. Asare Christian (Guest): All right. If an individual has a stroke, multiple things can happen. One of the things that most individuals experience with stroke are motor deficits, meaning weakness, as well as some cognitive issues. They can also have problems with their bowel, bladder. A whole lot of issues that the majority of individuals have problems with is their muscles following a stroke event.
Melanie: So then, what would be the cause of that spasticity? Speak a little bit about the etiology of it.
Dr. Christian: Spasticity is caused by something we call an upper motor neuron lesion. Basically, in the absence of a stroke, you have all of these connections from your brain into your muscles that allow your muscles to contract the right way. For example, if you’re lifting something up with your arms, your biceps will activate, your triceps will relax, and all of this coordination is taken care of by the brain. We have contraction and co-contraction of different muscles, and your brain puts breaks on all of this muscle activation. When you have a stroke, what happens is that we have a lesion or something that impacts the ability of the brain to control those types of movements. Individuals can develop spasticity where there is now stiffness, or there is one muscle contracting more than the other. This can lead to pain, and this can lead to multiple complications.
Melanie: Speak about some of those complications.
Dr. Christian: One that I mentioned, is pain. Pain can be significant for patients with spasticity. We can also have problems with skin breakdown because if you have a constant state of contraction, skin can break down. It’s also hard for individuals to do basic ADLs or self-care. If your hand is contracted, it might be very difficult for you to put on your clothing. It might be very difficult for you to use your hand. Subsequently, if we don’t treat this, this can also lead to contractures where there is a permanent shortening of the tendons. This may require surgery or other complications arise as just outlined.
Melanie: Dr. Christian, tell us about your multidisciplinary approach to treat spasticity, and what type of providers are involved? Is this a very cohesive situation to work with?
Dr. Christian: Yeah, so spasticity management is as you mentioned, a comprehensive approach. The paradigm for treatment includes physical therapy, stretching, medications, injections with Botox. We can also do Phenol injections, so there is a huge spectrum based on the patient’s need. One of the things we focus on in our practice is trying to provide value to the patient. What we do is what is the spasticity preventing the patient from doing? What are the patient’s goals? What are their functional needs? We sit down with the patient; we talk to the team, the therapist, as well as the rest of the patient’s family, to try and create a goal and subsequently, we’ll come up with a plan to address and achieve that goal for the patient.
Melanie: What are some of the non-surgical treatments that are available? If surgery is required in severe cases, get into that a little bit, but start with some of the non-invasive treatments.
Dr. Christian: The majority of individuals as you pointed out, would not require surgery for spasticity, especially for stroke. Treatment starts with physical therapy, stretching. Heat tends to work very well for stiff muscle. Modalities of heat, ultrasound, TENS units, all of those can play a role in treatment. We can also use medications. There are multiple medications that we can use for patients. And then, if all of that does not work for the patient – or based on the type of spasticity – when we talk about spasticity, we have focalized where there is a specific area of the body that’s affected, or you can have generalized spasticity where it’s all over the place. That becomes hard to treat with botulin toxin. Based on the type of spasticity that individuals have, we can use this non-surgical approach – i.e., physical therapy, occupational therapy, medications, and then potentially, Botox injections as needed.
Melanie: Speak a little bit about the rehabilitation technology which can provide passive or assisted movement help for people that suffer from this.
Dr. Christian: Yeah, so there are multiple technologies out there for rehabilitation for individuals with spasticity. The ones that we know that work very well actually tends to be very simple, just range of motion. There are multiple types of equipment that we have at our disposal to help us with that. We actually have Exoskeletons, specifically, at Good Shepherd, to help with mobility and to improve muscle strength and lengthening. We also have functional FES; there are multiple bikes. We have zero-gravity therapy modalities and multiple technologists here at our disposal to address the specific needs of our patients.
Melanie: Dr. Christian, tell us about your team at Good Shepherd Rehabilitation Network.
Dr. Christian: We have an excellent team of clinicians here at Good Shepherd. Good Shepherd has been around for almost 100 years, so we have had a lot of experience dealing with individuals with functional impairment and disability. Our approach here is a comprehensive approach. We want patients and families to achieve their goals. Everybody’s goal will be different, so irrespective of what the patient is coming from, we try to set realistic goals for the patient. The team here, as I mentioned earlier, consists of our physical therapists. We also have neuropsychologists; we have speech pathologists. We have assistive technology individuals and other staff who all work with the team with the goal of trying to improve function for the patient.
Melanie: Now, wrap it up for us. Tell other providers what you want them to know about spasticity management and when you feel it’s appropriate for them to refer to the specialists at Good Shepherd Rehabilitation Network.
Dr. Christian: Yeah, so spasticity can affect a lot of patients with stroke. A lot of times, it does go unrecognized or untreated. Spasticity can lead to pain. It can lead to complications of skin breakdown; it can lead to contractures. It can also lead to increased energy expenditure. As it turns out, if you have spasticity, it actually requires a lot of energy to move your muscles, so what we’d like for providers and other clinicians to understand is that we have a comprehensive approach to spasticity management. We have physical therapists, occupational therapists. We have experience and expertise in the management of spasticity with botulin toxin, with baclofen pumps, and potentially, if the patient does require further management, we have networks of other physicians or surgeons that we can refer to. Our goal here is a comprehensive approach to care, so if an individual gets here, we will make sure that all of their needs are addressed in terms function as it relates to spasticity.
Melanie: Thank you so much. What great information, Doctor. Thank you for joining us today. This is Be Well, the podcast from the rehabilitation experts at Good Shepherd Rehabilitation Network. For more information on resources available at Good Shepherd Rehabilitation Network, please visit GoodShepherdRehab.org, that's GoodShepherdRehab.org. This is Melanie Cole. Thanks so much, for listening.