Melanie Cole (Host): Welcome to UAB Med Cast. I'm Melanie Cole. And today we're discussing spasticity rehabilitation and treatment with my guest, Dr. Bobby Brunner. He's a physiatrist and the medical director of the UAB Spain Rehabilitation Center. Dr. Brunner, it's a pleasure to have you join us today. I'd like you to start out kind of with a table setting for us, define spasticity for us as it applies to what we're discussing today?

Dr Bobby Brunner: Yeah, spasticity is a condition in which there is an abnormal increase in muscle tone or stiffness of the muscle, which might interfere with an individual's movement, their speech, or be associated with discomfort or pain. Spasticity is usually caused, by damage to the central, nervous system, which includes the brain and, spinal cord and interferes with the control of muscular movement. So the degree of spasticity varies for mild muscle stiffness in some individuals to severe painful and uncontrollable, muscle spasms in.

Melanie Cole (Host): So tell us a little bit about the conditions and diagnoses that are associated with spasticity, because there is this big wide range in the spectrum of movement disorders, but we're focusing on spasticity today? So tell us a little bit about those conditions and diagnoses.

Dr Bobby Brunner: Yeah. So the conditions you see generally are any condition that can affect the brain and spinal cord. So it's seen association in individuals that may get a spinal cord injury, they get a trauma to their spinal cord and it upregulates, the system and develop spasticity. It can be seen in autoimmune disorders and example would be something like multiple sclerosis, we're not talking about kids today, but kids do turn into adults with cerebral palsy.

That's a one time incident at birth, but they do turn into adults. So you see the kids, but, it continues in adults. Things like stroke, cerebral vascular accidents, can lead to, spasticity brain disease, such as tumors or an individual with meningitis can develop spasticity or just head trauma. Really any injury disease that affects the spinal cord can lead to spasticity.

Melanie Cole (Host): well, then I think one of the most important things we're gonna discuss here today is quality of life for patients. Tell us a little bit about how this affects their quality of life as you see it, when you're working with patients?

Dr Bobby Brunner: So when we deal with patients with spasticity and quality of life, a lot of times, for example, we may get them into a rehabilitation program. And when they're trying to do things, with a therapist that can affect their ability to learn a certain technique or shorten gate, because a spasticity interferes with that. It can cause them ambulate in a different way. So if they're walking down a hallway, they may lead to a scissoring gate or a Hemi Paraic gate that can lead to fall. So falls, lead to other complications.

For lower level individuals that may be in wheelchairs. It can affect their positioning in wheelchairs. It can affect how they take care of themselves, how they eat, how they do their bowel or bladder function. So spasticity can affect, the general way one goes through life and it can be painful in some conditions, as well. So, we're trying to get their gate or their activity daily living to a point where they can, tolerate the underlying spasticity and doesn't affect them to a great degree.

Melanie Cole (Host): Well, then let's talk about the treatments that are available. What are you doing at UAB Spain Rehabilitation Center?

Dr Bobby Brunner: There are a variety of things that you can do to try to help minimize spasticity. We're not treating the underlying diagnosis. we're really treating this particular side effect. And so our goal is to minimize that effect and improve their quality of life overall. So sometimes you start simply with things like physical, occupational therapies. These are therapists that work to develop a regimen for you to, either, improve your gate or your basic, activities daily living. This can involve a stretching program or range of motion program.

The idea is to take that program and incorporate it into your life so that you can work on it every day so that you will, reduce, complications of shrinking muscles, which can lead to joint deformities and so forth. So that's one thing that we can do in a basic thing, that we do with individuals. Then kind of, after that, we would consider medication manage. And there are several medications. You hear names like Dantrium, Zudanazine, Baclofen. These are all medications that can help spasticity. They all medications that can have side effects.

So it's important to go over, if you're a provider, what those complications might be in discuss risk and benefits. Another option would be injection therapy, this is for the Bochilonum toxins. This is typically into muscles for a focal area of tone or spasticity. these are generally well tolerated. They're done generally every three months.. Again, there are side effects, so that's a thing to be aware of. But overall it's generally very well tolerated. Then, something more invasive would be, intrathecal, Baclofen. This is infused through a pump system.

So this will be implanted, by a surgeon, into the body, with the catheter going directly into the fluid around the spine to reduce spasticity, To do something like that. You have to go to somebody that deals with pumps. there's a trial period to see whether a patient, would even qualify or respond to the intrathecal Baclofen. But if they do, then you would talk about the risk benefits of implanting of pump. And these are battery devices that last about seven years. So there's surgery that you have to have a period of time.

And there are complications that occur that these systems have to be removed, but once it's effective, it's extremely effective and it reduces the need for medications or other, interventions, which is great. And it really helps people with lower extremity spasticity, particularly. And then the last option you have are surgical treatments. This isn't so much for spasticity reduction, but more the complications of spasticity. So if someone has contractures of the joint or deformities of the joint, then you might go to a surgeon that specializes in this area to do some surgery on the joints.

Or do tendon lengthening type procedures so that we can position the individual better, get them walking, or maybe they're functioning better as well. So that's kind of a global overview of the different treatments that there are for spasticity.

Melanie Cole (Host): And how have been your outcomes, Dr. Brunner, what have you seen and what have you heard from patients?

Dr Bobby Brunner: So the outcomes are variable. Of course it depends on each individual person. So it depends on the severity. So someone that has milder spasticity, and is headed for a shorter, length of time, the treatments can be very effective. And we like to get people early, too, so that we can prevent these longer term complications. But if you get somebody that's maybe more severely impaired has more generalized spasticity all over has had it for a longer time or has an underlying illness that is potentially progressive, then sometimes the spasticity can be harder to control.

But overall, our goal is to reduce the impact of the spasticity on the individual so that we can get them functioning to the best of their ability to keep them comfortable, to help them, with their day in and day out, life. So, the point is that there are treatments to make people more functional and more comfortable. And I think earlier that you get interventions or get these treated or work on this, then you reduce the long term complications.

Melanie Cole (Host): As we wrap up, Dr. Bruner, can you describe the parameters that would indicate a patient should be evaluated to determine if they are suffering from spasticity as a result of a movement disorder?

Dr Bobby Brunner: Yeah, I think earlier the better. So when we see somebody early on in spasticity, the joints are still very flexible mobile, the individual has not lost range of motion. And I think there's a lot we can do if we get to people early on, some people will. Just come into clinic or another provider and they see 'em walking with a stiff gate or they notice the range of motion, but they don't particularly think about referral or doing anything about it.

And that can lead to if years go by to further contracts, I mobility, poor positioning and chair, which then can lead to further painful conditions down the road. And so the key to me is early recognition, of this condition and then referral to an appropriate individual that can kind of go through these different, treatment plans and work with the patients so that, long term outcomes are much improved for the individual.

Melanie Cole (Host): Thank you so much, Dr. Bruner, for joining us today and sharing your expertise. And for more information, please visit our website at uabmedicine. org slash physician. That concludes this episode of UAB Medcast. I'm Melanie Cole