Spasticity Diagnosis and Management -- Contents -- I General Overview -- II Assessment Tools -- III Treatment of Spasticity -- IV Evaluation and Management of Diseases Involving Spasticity -- V Basic Science of Spasticity -- Preface -- Contributors -- Why Is Spasticity Important? -- Epidemiology of Spasticity in the Adult and Child -- STROKE -- SPINAL CORD INJURY -- Traumatic Brain Injury -- MULTIPLE SCLEROSIS -- CEREBRAL PALSY -- CONCLUSION -- References -- Spasticity and Other Signs of the Upper Motor Neuron Syndrome -- NEGATIVE SIGNS -- Impairment of Meaningful Action -- STRETCH SENSITIVE POSITIVE SIGNS -- Stretch Reflexes -- Phasic Stretch Reflexes and Clonus -- Tonic Stretch Reflexes -- Stretch Sensitive Cocontraction -- Stretch Sensitive Dystonia -- POSITIVE SIGNS THAT ARE NOT STRETCH-SENSITIVE -- Flexor and Extensor Spasms -- Associated Reactions -- Muscle Rheology -- MALADAPTIVE CONSEQUENCES OF THE UMNS -- CONCLUSIONS -- References -- Ancillary Findings Associated With Spasticity -- SENSORY DISTURBANCES -- VOICE, SPEECH, AND SWALLOWING -- Dysphagia -- Dysarthrias -- BOWEL AND BLADDER -- SLEEP -- Psychosocial Issues -- Case Study -- CONCLUSIONS -- References -- Measurement Tools and Treatment Outcomes in Patients With Spasticity -- Spasticity Outcome Measures-What Is a Useful Outcome Measure? -- Spasticity Outcome Measures-What Is a Useful Outcome Measure? -- An Organized Approach to Spasticity Outcomes -- PHYSIOLOGICAL MEASURES -- Measures of Passive Activity -- Measures of Voluntary Activity -- Passive and Active Function -- Quality of Life Measures -- Choosing an Outcome Measure to Assess Intervention Effectiveness -- Types of Assessment Methods and Tools -- Measures of Physiological Activity -- Measures Utilizing Nerve Conductions -- Tendon Reflex -- Measures of Passive Activity.

Ashworth, Modified Ashworth, and Modified Modified Ashworth Scales -- Range of Motion -- Stiffness and Muscle Tone -- Stretch and Stretch Reflexes -- The Pendulum Test Models -- Reflex Threshold Angle -- MEASURES OF VOLUNTARY ACTIVITY -- Isolated Voluntary Time Movement Tests -- Performance-Based Measures -- Pedobarography -- Detection of Movement -- Gait -- Balance -- Body Segment Analysis -- FUNCTIONAL MEASURES -- Visual Analog Scale and Likert Scale -- Timed Ambulation Tests -- Functional Performance Measures -- The Pediatric Evaluation of Disability Inventory -- Quality of Life Measures -- 36-Item Short Form Health Survey -- Satisfaction With Life Scale -- The EuroQol -- CONCLUSIONS -- References -- Assessment of Spasticity in the Upper Extremity -- Identifying Goals in Upper Extremity Assessment -- Anatomic Considerations in Assessing the Upper Extremity -- Assessment of the Shoulder -- Assessment of the Elbow -- Assessment of the Wrist -- Assessment of the Fingers -- Functional Considerations in Assessment of the Upper Extremity -- Development of the Treatment Plan to Assess Upper Extremity Spasticity -- Follow-Up Assessments of Upper Extremity Spasticity -- Summary -- References -- Identifying Goals in Upper Extremity Assessment -- Assessment of Spasticity and Other Consequences of the Upper Motor Neuron Syndrome Affecting the Low -- Clinical Assessment of Spasticity -- Functional Assessment of Gait to Evaluate Lower Limb Dysfunction -- References -- Setting Realistic and Meaningful Goals for Treatment -- Choosing Meaningful and Realistic Treatment Goals -- The Patient and the Clinical Presentation -- Available Support System -- Financial Resources -- The Skills of the Treatment Team and Availability of Different Treatment Modalities -- Determining Treatment Goals -- Conclusion: Synthesis of Information and Choosing Treatment Goals.

Case Discussions -- Case I -- Case II -- Case III -- Case IV -- Case V -- References -- Chemoneurolysis With Phenol and Alcohol: A "Dying Art" That Merits Revival -- CHEMICAL NEUROLYSIS -- PHENOL -- Phenol Neurolysis: Histologic Changes -- Technique of Injection for Phenol Neurolysis -- Site of Injection -- Duration of Action of Phenol Neurolysis -- Side Effects and Complications of Phenol Neurolysis -- ALCOHOL -- COMPARISON OF PHENOL NEUROLYSIS AND BT -- Hypothetical Cost Comparisons -- PEDIATRIC CONSIDERATIONS -- SUGGESTED APPROACHES FOR SPECIFIC UPPER MOTOR NEURON DISORDERS -- Examples and Recommendations -- Upper Body -- Lower Body -- CONCLUSION -- References -- Botulinum Toxin in the Treatment of Lower Limb Spasticity -- FUNCTIONAL IMPLICATIONS OF SPASTICITY -- CLINICAL ASSESSMENT OF SPASTICITY -- The Impact of Gait -- Patterns of UMN Dysfunction -- Equinovarus -- Hyperextended Great Toe -- Stiff Knee -- Adducted (Scissoring) Thigh -- Flexed Hip -- THE ROLE OF BoNT IN THE TREATMENT OF SPASTICITY -- CONCLUSION -- References -- Botulinum Toxin in the Treatment of Upper Limb Spasticity -- Mechanism of Action of BoNT -- Concerns on Dosing -- Why Does BoNT Work for Spasticity? -- Studies of BoNT-ona in Poststroke Spasticity -- Sustained Improvement With Repeated Injections -- Studies of BoNT-abo -- Studies of BoNT Type B in Spasticity -- Defining Clinical Impact -- Common Presentations of Upper Extremity Spasticity -- Clinical Presentations -- Injection Technique -- Case report 1: Treatment to Improve Passive Function -- Case Report 2: Treatment to Improve Active Function -- Consensus Statements and Evidence Reviews -- Summary -- References -- Anatomical Correlation of Common Patterns of Spasticity -- THE SHOULDER -- Anatomy -- Spastic Postures -- THE ELBOW -- THE WRIST -- THE HAND -- Anatomy -- Spastic Postures -- THE HIP -- THE KNEE.

THE ANKLE AND FOOT -- References -- The Role of Physical and Occupational Therapy in the Evaluation and Management of Spasticity -- FACTORS TO CONSIDER -- EVALUATION -- Physical Assessments -- Patient Reported Assessments -- Functional Assessments -- TREATMENT OPTIONS -- Physical Treatments -- Stretching -- Serial Casting -- Saeboflex -- Dynasplints -- Lycra Garments -- THERAPEUTIC EXERCISE -- Unloaded Cycling -- Body Weight-Supported Ambulation -- Strength Training -- MODALITIES -- Electrical Stimulation -- Functional ES -- Transcutaneous Electrical Nerve Stimulation -- Thermal Modalities -- Cold -- Heat -- COMBINATION THERAPIES -- Botulinum Toxin Type A Injection and Electrical Modalities -- Botulinum Toxin Type A Injection and CIMT -- Botulinum Toxin Type A Injection and Therapeutic Exercise -- Botulinum Toxin Type A Injection and SC -- SUMMARY -- References -- Emerging Technologies in the Management of Upper Motor Neuron Syndromes -- Neuroimaging Technologies -- Diffusion Imaging -- Magnetic Resonance Spectroscopy -- Functional Magnetic Resonance Imaging -- Functional Near Infrared Spectroscopy -- Emerging Treatments -- Constraint-Induced Movement Therapy -- Virtual Reality -- Transcranial Magnetic Stimulation -- Electric Stimulation -- Robot Therapy -- Body Weight-Supported Treadmill Training -- Conclusions -- References -- Pharmacologic Management of Spasticity: Oral Medications -- Gamma-Aminobutyric Acid Agonists -- Baclofen -- Pharmacokinetics -- Treatment -- Benzodiazepine Derivatives -- Diazepam -- Clonazepam -- Pharmacokinetics -- Treatment -- Other GABA derivatives -- Gabapentin -- Pharmacokinetics -- Treatment -- Tiagabine -- Pharmacokinetics -- Treatment -- Vigabatrin -- Pharmacokinetics -- Treatment -- Topiramate -- Pharmacokinetics -- Treatment -- Central Alpha-Adrenergic Agents -- Clonidine -- Pharmacokinetics -- Treatment.

Tizanidine -- Pharmacokinetics -- Treatment -- Serotonergic agents -- Cyproheptadine -- Pharmacokinetics -- Treatment -- Cannabinoids -- Dronabinol -- Nabilone -- Pharmacokinetics -- Treatment -- OTHER AGENTS -- Dantrolene Sodium -- Pharmacokinetics -- Treatment -- Cyclobenzaprine -- Pharmacokinetics -- Treatment -- Orphenadrine -- Pharmacokinetics -- Treatment -- Treatment Paradigms Spinal Disorders Versus Cerebral Disorders -- References -- 169 -- Intrathecal Baclofen for Spasticity -- HISTORY OF ITB THERAPY -- INTRATHECAL BACLOFEN INFUSION -- Neurophysiological Mechanism of Action -- Components of ITB Therapy -- Patient Selection and the Role of Preimplant Trials -- IMPLANTATION -- Titration Phase and Postimplantation Management -- Long-Term Maintenance -- EXPERIENCE WITH SPECIFIC PATIENT GROUPS -- Children -- Ambulatory Patients -- APPARENT LOSS OF DRUG EFFECT, WITHDRAWAL, SYSTEM MALFUNCTIONS, AND TROUBLESHOOTING -- SUMMARY -- References -- Surgery in the Management of Spasticity -- Philosophy of Surgery for Spasticity -- History of Surgical Interventions in Spasticity -- Goals of Surgery for Spasticity -- Factors Important the Decision-Making Process -- Appropriate Timing for Intervention -- Planning Surgery for Spasticity -- Specific Surgical Techniques for Treatment of Spasticity -- Surgery Management of Specific Conditions -- Upper Extremity -- Shoulder Adduction, Internal Rotation Spasticity -- Elbow Flexion Spasticity -- Forearm Pronation Spasticity -- Wrist Flexion Spasticity -- Finger Flexion Spasticity (Extrinsic Hand Spasticity) -- Hand Spasticity (Intrinsic Spasticity) -- Finger Flexion Spasticity -- Thumb Spasticity (Intrinsic Spasticity) -- Lower Extremity (30, 44-50) -- Hip Flexion and Adduction Spasticity -- Hip Extension Spasticity -- Knee Flexion Spasticity -- Knee Extension Spasticity -- Foot and Ankle Spasticity.

Equinus Ankle Spasticity.