Physical and Occupational Approaches

Abstract

Most approaches by physical and occupational therapists are founded in neurophysiologic, neurodevelopmental, or clinical principles. Unfortunately, there is little level I evidence to support any one of these therapeutic approaches. Yet most of the enduring approaches to spasticity management by therapists persist because they are felt to be effective. These therapeutic approaches have treatment goals that include the achievement of normal motor performance, orderly developmental sequences, and functional mobility. Gillette described each of these clinical approaches as being centered about one or more clinical phenomena occurring in the neurologically injured patient. These phenomena include righting reflexes, reciprocal inhibition, synergistic patterns of movement, and sensory functions such as proprioception, vision, and temperature perception (1). Physical therapy theory holds that any effective treatment program for spasticity also includes efforts aimed at enhancing normal motor control, ensuring optimal physical conditioning, and preventing deformity, skin breakdown, and other complications of spasticity. The treatment of spasticity must be cost-effective and allow for transition out of the medical model and towards resumption of daily life. Table 1 details the fundamental tenants in the management of spasticity that are central to the physical-therapeutic approach to every patient with spasticity.