[Measuring outcome in spasticity rehabilitation].
Spasticity is a frequent consequence of upper motor neuron lesion and is associated with a variety of symptoms such as pain, muscle stiffness and reflex patterns that interfere with activities of daily living, dexterity and gait. As therapy strategies in managing spasticity-associated problems have been evolving there is an increasing need for a practicable documentation system which describes spasticity and related symptoms on different levels in order to evaluate especially the level of functioning. In daily routine the single-case-design reflects a useful technique to evaluate the status in terms of technical, functional and individual goals for treatment. However, there is no single tool to measure the different types of changes due to treatment, therefore a variety of selecting tests, based on the functional changes expected from the selected treatment, is recommended. The sensitivity of the selected tests should match the range of expected improvements related to the specific treatment. Technical goals should be evaluated by validated spasticity rating scales. As changes in technical measures of spasticity such as muscle tone, muscle length, range of motion or repetitive voluntary movements may not correlate with clinical improvements, individual functional goals should be defined. Those functional goals should reflect the patients' and care-givers' individual perception of the actual problem. A treatment diary is a useful tool to document subjective perception of changes over time. Some practical issues are adressed below. Reliable outcome measures enable patients and doctors to select further treatment strategies and gives health care providers information on treatment expectations in return for their investments.
Fheodoroff
K
K
Abteilung für Neurologische Rehabilitation, Gailtal-Klinik Hermagor, Osterreich. k.fheo@netway.at
Wissel
J
J
Entner
T
T
Freimüller
M
M
D000203:Activities of Daily Living; D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D017028:Caregivers; D002648:Child; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D006801:Humans; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000191:economics / Q000503:physiopathology / Q000534:rehabilitation*; D009129:Muscle Tonus; D009132:Muscles / Q000502:physiology; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D017063:Outcome Assessment, Health Care; D010146:Pain / Q000175:diagnosis / Q000209:etiology; D017060:Patient Satisfaction; D026741:Physical Therapy Modalities; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D016059:Range of Motion, Articular; D012680:Sensitivity and Specificity; D013997:Time Factors; D016896:Treatment Outcome
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A