Therapeutic Consideration for Medical/Surgical Management of Movement Disorder

Question 1

What is the order from how compensation can lead to a deformity

Answer 1

Compensation –> Habit –> Contracture –> Deformity

Question 2

When making a decision on medical and surgical management what are some things to keep in mind?

Answer 2

• Patient centered
• Multidisciplinary approach

Question 3

What is medical and surgical management based on?

Answer 3

• Function/limitation of function
• Pain

Question 4

What are some spasticity management options?

Answer 4

• Pharmacological management
• Selective Dorsal Rhizotomy
• Others in specific movement disorders (Stereotactic Neurosurgery & Deep Brain Stimulation)

Question 5

What is the purpose of anti spasticity /Skeletal muscle relaxants?

Answer 5

Decrease tone & control involuntary movements

Question 6

What are the central acting pharmacological management of movement disorders?

Answer 6

• Baclofen (Lioresal)
• DIazepam (Valium)

Question 7

How is Baclofen administrated?

Answer 7

• Oral
• Continuous Intrathecal Baclofen Infusion (CIBI)

Question 8

How does continuous intrathecal baclofen infusion work?

Answer 8

• Intrathecal delivery with implanted pump
• Small catheter implanted surgically into subarachnoid space at specific area of cord
• Programmable pump implanted subcutaneously in abdominal area, programmed to deliver slow/continuous amounts of drug

Question 9

T/F: Antispasticity/Skeletal muscle relaxants are not direct acting on skeletal muscle

Answer 9

False they are
- Dantrolene Sodium (Dantrium)

Question 10

Where are motor point blocks/nerve blocks injected?

Answer 10

6% solution of (phenol) alcohol injected into motor point of muscle or peripheral nerve –> Neurolysis

Question 11

How long does motor point blocks/nerve blocks decrease tone for?

Answer 11

Lasting 3-6 months

Question 12

What is the negative to motor point blocks/nerve blocks?

Answer 12

Sometime difficult to get motor without sensory

Question 13

What is the mechanism of Botulinum Toxin?

Answer 13

Binds to acetylcholine vesicles at NM junction and interrupts synaptic activity

Question 14

Where is Botulinum Toxin injected and when does relaxation occur?

Answer 14

• Injected into muscles
• Relaxation in several days

Question 15

What is the benefit and con of Botulinum Toxin?

Answer 15

• Benefit: May help to delay surgery or decrease number of surgical procedures
• Con: May require re injection

Question 16

What is Transdermal Clonidine and how is it administered?

Answer 16

• Muscle relaxant
• Administered: via patch

Question 17

How can antiepileptic drug be used for movement disorder?

Answer 17

May block random firing of neurons

Question 18

What is the implications of a PT in concerns to Botox?

Answer 18

• Timing of intervention
• Adjuncts to botox

Question 19

What are some neurosurgical management of movement disorders?

Answer 19

• Neurectomy (partial or complete)
• Myelotomy
• Localized cordectomy
• Selective Dorsal Rhizotomy (SDR)

Question 20

What is a myelotomy?

Answer 20

Severance of spinal cord nerve fibers

Question 21

What is a localized cordectomy?

Answer 21

Severance and removal of tissue from cord

Question 22

How is a selective dorsal rhizotomy performed?

Answer 22

Surgical reduction of input from sensory fibers

Question 23

What is the criteria to select the patient for selective dorsal rhizotomy?

Answer 23

• Male 3-14 y/o & Female 3-12 y/o
• No severe contractures, weakness secondary to multiple orthopedic procedures, additional disorders, severe scoliosis or TBI
• Age appropriately cognitively
• Family compliance
• Availability of intensive post op PT

Question 24

What are some PT treatments post Rhizotomy?

Answer 24

• Muscle stretching to gain joint mobility & range
• Muscle strengthening to increase endurance
• Muscle reeducation to impart a better pattern of muscle use