Spasticity 2(1) - Tagged

Patterns of Deformity

• Types of Management

  • Focus on spasticity management

  • Presented by Apollo Health Group

• Services Offered

  • Paediatric & Neuro Rehabilitation

  • Adult & Neuro Rehabilitation

  • Surgical & Medical Services

Development of Deformity

• Causes of Deformity

  • Decreased Muscle Length during growth:

    • Leads to muscle shortening and dysfunction.

  • Abnormal Muscle Activity and Balance:

    • This can alter muscle coordination and strength.

  • Muscle and Connective Tissue Adaptation:

    • Over time, muscles and connective tissues adapt abnormally to stress.

  • Muscle and Joint Contracture:

    • Limitation in joint motion due to muscle tightness.

  • Muscle and Joint Laxity:

    • Excessive flexibility in joints may cause instability.

Consequences of Deformity

• Physical Consequences

  • Pain and discomfort leading to reduced mobility.

  • Difficulty in maintaining hygiene which can lead to infections.

• Functional Consequences

  • Reduced upper limb function impacting daily activities.

  • Reduced sensory stimulation affecting perception.

• Psychosocial Consequences

  • Altered posture can lead to poor body image.

  • Overall reduced quality of life.

Knowing Your Anatomy

• Key Muscles Involved

  • Flexor Pollicis Longus

  • Pronator Quadratus

  • Flexor Digitorum Profundus

  • Referenced from Teach Me Anatomy.

Superficial Muscles of the Forearm

• Key Superficial Muscles

  • Brachioradialis

  • Flexor Carpi Radialis

  • Flexor Carpi Ulnaris

  • Pronator Teres

  • Palmaris Longus

• Source: Illustrated Clinical Anatomy by Abrahams, Craven, and Lumley.

Deep Muscles of the Forearm

• Key Deep Muscles

  • Supinator

  • Flexor Digitorum Profundus

  • Flexor Pollicis Longus

  • Pronator Quadratus

• Source: Illustrated Clinical Anatomy by Abrahams, Craven, and Lumley.

Management of Evolving Deformities in the Upper Limb

• Importance of understanding and preventing the development of deformities.

Patterns of Deformity in Upper Limb (Research Study)

• Frequent Pattern Identified

  • AP III (41.8%):

    • Internal rotation & shoulder adduction, flexion at the elbow, neutral forearm and wrist position (1).

• Studies and Sources: Hefter et al. 2012.

Specific Upper Limb Positioning

• Various positions leading to deformities:

  • Internal rotation, adducted with flexed elbow and clenched hand.

  • Variations on wrist positioning (supinated vs extended) affect limb function.

Upper Limb Assessment

• Holistic Approach

  • Assess posture, muscle tone, and function during various activities (lying, sitting, standing).

  • Importance of evaluating muscle balance and compensatory movement strategies.

Lower Limb Patterns of Deformity

• Overview of common lower limb deformities and their management.

Spasticity Development in Children

• Spasticity Characteristics

  • Develops progressively with growth and activity.

  • Predominant patterns include:

    • Hip flexion, adduction, internal rotation, knee flexion, and ankle equinovarus.

Muscles Involved in Plantarflexion

• Key Muscles

  • Gastrocnemius (prime mover)

  • Soleus (prime mover)

  • Additional assisting muscles: tibialis posterior, plantaris, flexor digitorum longus, and flexor hallucis longus.

Equinovarus Deformities

• Types of Contractures

  • Dynamic Contracture:

    • Due to hypertonicity of crural muscles.

  • Myostatic Contracture:

    • Irreversible shortening of muscles, needing effective management to avoid.

Alternative/Additive Treatment Methods

• Treatment Options

  • Physiotherapy (stretching/strengthening)

  • Tone-reducing medications

  • Functional Electrical Stimulation (FES)

  • Ankle Foot Orthoses (AFOs)

  • Orthopaedic interventions (e.g., SDR, ITB) for permanent solutions.

Conclusion

• Thank you for your attention.

• Open invitation for any questions.