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Spasticity Management

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Treatment for Spasticity
METHOD AGE(YEARS) DIAGNOSIS CHAR- ACTERISTICS EXPECTED RESULTS Follow-up Care OUTCOME SIDE EFFECTS; RISK COST ESTIMATES
ORAL MEDI- CATIONS Any age most often 2-5 yrs Spastic        quad- triplegia TBI Diffuse Spasticity Mild decrease in Spasticity in arms and legs PT/OT as needed Often need   SDR or ITB   later Drowsiness
Medications=
$ 40-60
Each month

 
BOTOX INJECTIONS Any age: less often over 10 Spastic        Diplegia; Spastic quadriplegia TBI Isolated Spasticity   Too young     for SDR, ITB Decrease in Spasticity injected muscles(s) for 2-4 months PT,OT, to increase range of motion and to increase strength Improved      gait;    sometimes improved arm function None with usual doses
Procedure:
(injection's)
$250-$400 Medication    each time,cost depends  ondosage=  $400 -800    (Every 3-4 months)
RHIZOTOMY SDR 4-8(most common) Spastic          diplegia or quadriplegia     capable of ADLs Good leg strength; no severe con- tractures; motivation      for PT Marked, permanent, non adjustable decrease in spasticity Extensive PT/OT Improved walking;
infection: 2%
Wound: 1%
Spinal fluid leak: 3%

 
Hospitalization and surgical procedures= $20,000-
25,000
Intensive PT during first year   = $10,000-
$25,000

 
Spastic     quadriplegia; not capable of ADLs Severe leg spasticity; interferes    with care Minimal Improved     ADLs;     decrease in orthopedic operations Easier care
Infection: 2%
Wound: 1%
Spinal fluid leak: 3%

 
BACLOFEN ITB Over age 3: big enough to insert pump Spastic quadriplegia;   spasticity in legs greater than or equal to spasticity in arms; capable of ADLs Severe spasticity; positive response        to test dose; spasticity limits function Decrease in spasticity Frequency of PT,OT depends on goals Improved walking; improved    ADLs;     improved speech; decrease in orthopedic operations; easier care
Infection: 5-10%
Wound: 5-10%
Spinal fluid leaks:   5-10%

 
Hospital- ization,
implant proceedure,
pump= $20,000-
$25,000
Initial medication= $400
Medication refills (3-5/year)= $200-300
(New pump; repeat hospital- ization and procedure every 4-5 years)
TBI Sever Spasticity interferes with care; positive response   to test  dose; spasticity limits   ADLs
Spastic quadriplegia; not capable of ADLs Minimal PT Easier Care
OT/PT Any age Spasticity of any extremity Spasticity impairs function or reduces range of motion Increased rage of motion, strength, function Depends on goals, motivation Improved function or ease of care, minimize deformity None $100-     $150 per  treatment session
ORTHOPEDIC SURGERY Any age, most common over 4 years Hip disloc- ations Muscle/ tendon contractures Bone/joint deformities Con- tractures Bone Deform- ities Increased range of motion; improved gait; decreased deformity PT, depending on goals Depends on goals
Infection 25%Bony     non- unions    25%
Re- constructions

 

 $20,000 or more
KEY TO TERMS: PT: Physical Therapy; OT: Occupational Therapy; TBI: Traumatic Brain Injury
 
 

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