Handling of the patient.
Spasticity
Spasticity: Often higher
on Mondays, with infections of the bladder and injuries at the toes
or elsewhere. Apart from these specific cases, spasticity usually
is reduced in the course of a training session . Only rarely the
opposite happens, in this case check the position of the harness:
Ease a too high pressure possibly put on the adductors. Otherwise
stop training for this day and try to find out the cause for the
enhanced spasticity.
Clonus: When clonus in the ankle and/or knee
joints develops this is often a sign of the patient getting tired
and loosing attention. Try to have the patient put more weight onto
the limb early in stance; calm him down, try reduced speed. Help
with knee extension, perform already during heel strike. If all
fails take a short break. It is the quality of walking which counts,
not primarily quantity of movement however performed.
Antispastic medication: Antispastic drugs may
reduce voluntary activity as well, thus we try to avoid them as
much as possible. When reducing the amount taken (gradually over
weeks), some problems during the night might arise with spastic
movements (with the blankets being delivered to the ground). Chronic
patients who are used to take the antispastic drugs often realize
an increase in voluntary force upon withdrawing and such patients
will tolerate the nightly troubles. It is worse with acute patients
who don't have these experience. However, we don't in all patients
reduce antispastic drugs to zero, usually it is a matter of titration
between reduction in voluntary activity and too high spasticity.
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