SPASTICITY AND ITS MANAGEMENT WITH PHYSICAL THERAPY APPLICATIONS WITH MULTIPLE SCLEROSIS PATIENTS

SPASTICITY AND ITS MANAGEMENT WITH PHYSICAL THERAPY APPLICATIONS WITH MULTIPLE SCLEROSIS PATIENTS

CONTENTS

FOREWORD

PREFACE

Chapter 1 INTRODUCTION

References

Chapter 2 OVERVIEW OF MS

2.1. Abstract

2.2. Introduction

2.3. MS And PATHOPHYSIOLOGY

2.4. TYPES of MS

2.4.2. Progressive MS

Primary progressive MS (PPMS)

Secondary Progressive MS (SPMS

Progressive Relapsing MS (PRMS)

2.5. Symptoms of MS

2.5.1. Weakness

2.5.2. Ataxia and Balance Deficits

Sensory Ataxia

Vestibular Ataxia

Cerebellar Ataxia

2.5.3. Fatigue

2.5.4. Bladder and Bowel Dysfunctions

2.6. DIAGNOSIS for MS

2.7. Medical Treatment Strategies and their Effects on Physical Therapy Applications

2.8. Conclusion

2.9. References

Appendix 1

Functional Systems

The Expanded Disability Status Scale (EDSS)

Chapter 3 SPASTICITY

3.1. Abstract

3.2. Introduction

3.3. Neurophysiology of Spinal Reflexes

3.4. Spinal Mechanism of Spasticity

3.4.1. Changes in Motor-Neuron Inhibition

Alteration of Reciprocal Ia Inhibition

Alteration of Recurrent Inhibition

Alteration of Autogenic Inhibition

Fusimotor Activity

Alteration of Cellular Levels

Others

3.5. Supraspinal Mechanism of Spasticity

3.6. Other Characteristics of Spasticity

3.6.1. Clasp Knife Phenomenon

3.6.2. Flexor Spasms

3.6.3. Associated Reactions

3.7. Conclusion

3.8. References

Chapter 4 MS AND SPASTICITY

4.1. Abstract

4.2. Introduction

4.3. Characteristics and Adverse Effects of Spastisity in MS Patients

4.4. Factors Aggravating the Severity of Spasticity

4.5. Conclusion

4.6. References

Chapter 5 POSTURE AND BODY MECHANICS

5.1. Abstract

5.2. Introduction

5.3. Body Segments and their Movements

5.3.1. Gravitational Factors and Their Effects on Posture

5.3.2. The Effects of Bad Posture on Body Tissues and Nervous System

5.4. Methods of Postural Management

5.5. Altrenative Therapy Techniques to Re-Educate Posture

5.5.1. The Alexander Technique

5.5.2. The Feldenkrais Method

Awareness through Movement

Functional Integration

5.5.3. Pilates

5.6. Conclusion

5.7. References

Chapter 6 NEUROPHYSIOLOGICAL BASIS OF FACILITATION AND INHIBITION TECHNIQUES

6.1. Abstract

6.2. Introduction

6.3. Proprioceptive System and Proper Stimulus

Proper Facilitation Alternatives

Proper Facilitation Alternatives

Proper Facilitation Alternatives

6.4. Cutaneous System and Proper Stimulus

6.5. Types of Muscle Fiber and Physiological Features

6.5.1. Treatment Principles According to Muscle Types

TONIC (POSTURAL) MUSCLES

Clinical signs of weakness:

PHASIC (MOVEMENT) MUSCLES

Principles of treatment of weak muscles:

6.6. Conclusion

6.7. References

Chapter 7 EVALUATION OF THE PATIENT AND MEASUREMENT OF SPASTICITY

7.1. Abstract

7.2. Introducton

7.3. Examination of a Spastic Patient

7.4. Primary Techniques

7.4.1. Clinical Scales

Ashworth and Modified Ashworth Scale

Tardieu Scale

Multiple Sclerosis Spasticity Scale

Numeric Rating Scale

Spasm Frequency Scale-Penn Spasm Scale

7.4.2. Biomechanical Measurements

Pendulum Test

Isokinetic Dynamometer

7.4.3. Neurophysiological Measurements

Hoffmann Reflex

H/M Ratio

F Response - F/M Ratio

7.5. Secondary Measurements

7.6. Conclusion

7.7. References

Appendicies

APPENDIX 1

Ashworth Scale

APPENDIX 2

Modified Ashworth Scale

APPENDIX 3

Tardieu Scale

APPENDIX 4

Multiple Sclerosis Spasticity Scale (MSSS-88)

Section 1:

Section :2

Section 3:

Section 4:

Section 5:

Section 6:

Section 7:

Section 8:

APPENDIX 5

Numeric Rating Scale

APPENDIX 6

Spasm Frequency Scale

APPENDIX 7

Penn Spasm Frequency Scale

APPENDIX 8

Hacettepe University Department of Physical Therapy, Neurological Rehabilitation Unit : Spastic Patient Assessment Form

Numeric Rating Scale

Goniometric Measurement

Posture Analyses

Observational Gait Analyses

Pathological Reflex Assessment

Muscle Strength Test

Total Point of Questionares

Superficial Sensory Assessment

Chapter 8 PHYSIOTHERAPY APPLICATIONS

8.1. Abstract

8.2 Introducton

8.2.1. Beginning and Early Phase (1 to 5.5 EDSS)

8.2.2. Middle phase (6 to 7 EDSS)

8.2.3. Advanced Phase (7.5 to 9.5 EDSS)

8.3. Direct/Local Approaches

8.3.1. Cold Application

Prolonged Cold Application

Short-Term Cold Application

8.3.2. Passive Exercises

8.3.3. Stretching

Slow And Prolonged Stretching

Quick Stretching

8.3.4. Neural Mobilization

8.3.5. Orthotic Devices

Lower Extremity Orthoses

AFOs Made of Leather and Metal

Polypropylen AFO

Long Leg Orthosis (Knee ankle foot orthosis (KAFO))

Upper Extremity Splints

8.3.6 Positioning

8.3.7. Manual Therapy

Approximation

Inhibitory Pressure

Stretch Pressure and Stretch Release

Slow Stroking

Soft Tissue Mobilization

Joint Mobilisation

8.3.8. Vibration

8.3.9. Electrical Stimulation

8.3.10. Biofeedback

8.3.11. Kinesiotape Application

8.4. Indirect (General) Approaches

8.4.1. Neuro-Developmental Treatment Methods

Bobath Concept

Johnstone Concept

Rood Concept

8.4.2. Proprioceptive Neuromuscular Facilitation

8.4.3. Body Image and Sensory Integration Training

8.4.4. Vestibular Stimulation

8.4.5. Hippotherapy

8.4.6. Hydrotherapy

8.4.7. Reflexology

8.5. Conclusion

8.6. References

Chapter 9 RELAXATION AND ENERGY CONVERSATION TECHNIQUES

9.1. Abstract

9.2. Introduction

9.3. Relaxation Techniques

9.3.1. Example of Respiratory Exercise

9.3.2. Progressive Relaxation Technique

9.3.3. Accelerated Progressive Relaxation Technique

9.3.4. Biofeedback

9.3.5. Autogenetic Relaxation Technique

9.4. Energy Conservation Techniques

9.5. Conclusion

9.6. References

Chapter 10 CASE HISTORY: PROBLEM SOLVING

10.1 Introduction

10.2. CASE

10.3. RESULTS

10.4. CONCLUSION

INDEX

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