Understand & Treating Spasticity - Yale Medicine Explains

Transcript

• 00:06When we want to move
• 00:07our body, we have impulses
• 00:09that come from our brain
• 00:11that send signals
• 00:12down the spinal cord to
• 00:14the nerves that innervate our
• 00:16muscles, and
• 00:17these muscles get a signal
• 00:18to move.
• 00:19And when we wanna stop
• 00:20moving, then the brain stops
• 00:22the signal and the muscle
• 00:23is able to relax.
• 00:25The problem in spasticity
• 00:27is the brain is telling
• 00:28that muscle to
• 00:30contract, to move all of
• 00:31the time.
• 00:33Spasticity
• 00:34is an abnormal firing of
• 00:36the nerves
• 00:37and it can happen after
• 00:39a brain injury or a
• 00:40spinal cord injury or certain
• 00:42other neurologic conditions.
• 00:44And we lose that ability
• 00:46to relax the muscle and
• 00:48to relax the motion.
• 00:50Because of the muscle tightness,
• 00:51it can cause abnormal positioning
• 00:53of their arms and
• 00:55stiffness in their joints that
• 00:57their joints,
• 00:58depending on severity, might not
• 00:59be able to
• 01:01move at all. Spasticity
• 01:02can be very limiting to
• 01:04functional activities, and of course,
• 01:06there's a range of spasticity
• 01:07from very mild to very,
• 01:08very involved.
• 01:10And so that's why it's
• 01:11so important to have a
• 01:13lot of different experts putting
• 01:14their heads together both to
• 01:16understand the patient's unique
• 01:18pattern of spasticity,
• 01:19but also how that's functionally
• 01:21impacting them and come up
• 01:22with treatment plans that will
• 01:24work for them.
• 01:25There's absolutely no cookie cutter
• 01:26approach to spasticity. We have
• 01:28to treat each patient and
• 01:29their particular patterns of muscle
• 01:31spasticity
• 01:33and their particular goals.
• 01:34Otherwise, we won't get the
• 01:36results that the patients are
• 01:37looking for.
• 01:43Yale looks at the individual
• 01:45as a whole.
• 01:46It's not just one specialist
• 01:48coming in and looking at
• 01:50that one part of the
• 01:51body. Usually, we'll start with
• 01:53physical or occupational therapy to
• 01:55really work on the muscle
• 01:56range of motion and try
• 01:58and help the muscle relax.
• 02:00And in cases where we
• 02:03really understand the affected muscles
• 02:05and it's not more widespread.
• 02:08We are able to come
• 02:09up with tentative
• 02:10surgical plans for the patients
• 02:12and then able to test
• 02:13them in real time,
• 02:15whether it's nerve blocks or
• 02:17Botox type treatments.
• 02:19We have a new therapy
• 02:21called cryoneurolysis.
• 02:22We're actually targeting the nerve
• 02:24that innervates the tight muscle
• 02:26and reducing the amount of
• 02:28nerve impulses coming into the
• 02:30muscle.
• 02:31So we can see the
• 02:32impact that nerve based procedures
• 02:34would have on the extremity.
• 02:36But it's also amazing because
• 02:37it lets us uncover
• 02:39tightness in the joints or
• 02:41shortness of the muscles, so
• 02:42we can determine if they
• 02:43also need more traditional
• 02:45tendon or joint based surgery.
• 02:48So they almost get to
• 02:49see a little bit what
• 02:50surgery would be like. So
• 02:52that is invaluable.
• 02:53And then if you take
• 02:54that the next step,
• 02:56having plastic surgery,
• 02:58nerve surgeon work together with
• 03:00an orthopedic surgeon brings two
• 03:02very different
• 03:03types of training together.
• 03:06So I'm able to find
• 03:07the nerve branches to some
• 03:09of the muscles.
• 03:10When the nerves are branching
• 03:11into tiny filaments and entering
• 03:13the muscle, I'm actually going
• 03:14and treating the spasticity as
• 03:16well by taking away eighty
• 03:17percent of the nerve fibers
• 03:19to reduce the the tone
• 03:21and give it a more
• 03:22normal amount of innovation.
• 03:25Now what we started doing
• 03:26is combining those methods with
• 03:28what's been done historically, what
• 03:30works for tendon lengthening,
• 03:32joint fusions, and things like
• 03:33that. So that we can
• 03:35target the too much nerve
• 03:37signal and also
• 03:38too short a muscle pathway.
• 03:41The two heads together
• 03:42actually comes up with a
• 03:44better result for the patient
• 03:45and allows us to do
• 03:46things to maximize
• 03:47their clinical result.
• 03:54We also have a team
• 03:55of excellent therapist and in
• 03:57our multidisciplinary
• 03:59clinic, we specifically have an
• 04:01occupational
• 04:01therapist.
• 04:02A lot of the procedures
• 04:03are getting them into a
• 04:04better position for function.
• 04:06So
• 04:07I'll brace them to make
• 04:08sure that we maintain that.
• 04:10And then after that,
• 04:12we talk about like how
• 04:14to actually use the function.
• 04:17What about the wrist?
• 04:18The wrist seems pointy. Me?
• 04:20Yes. I love it.
• 04:23It looks great.
• 04:24Doing some rehabilitation
• 04:26post surgery really leads to
• 04:28better outcomes
• 04:30and hopefully that the patient
• 04:31can have lasting results.
• 04:38You can break it in
• 04:39so you can touch her?
• 04:40Not or not body, just
• 04:42the hand.
• 04:43Yep.
• 04:44Yeah. Look at that.
• 04:46Adults with spasticity
• 04:48oftentimes have very complicated
• 04:50medical problems. They've had a
• 04:51big stroke or they had
• 04:52a big brain bleed, a
• 04:53spinal cord injury,
• 04:55and
• 04:56there can be so much
• 04:57focus on life and death
• 04:59at the beginning
• 05:00that they get forgotten.
• 05:02But if we can improve
• 05:04their comfort, their extremity function,
• 05:06the ability for folks to
• 05:07help take care of them,
• 05:09it can have a profound
• 05:10impact on them.