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.