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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.