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1.
Arch Phys Med Rehabil ; 99(8): 1681-1687, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29428347

RESUMO

The recognition, evaluation, and management of disabling spasticity in persons with spinal cord damage (SCD) is a challenge for health care professionals, institutions, health systems, and patients. To guide the assessment and management of disabling spasticity in individuals with SCD, the Ability Network, an international panel of clinical experts, developed a clinical care pathway. The aim of this pathway is to facilitate treatment decisions that take into account the effect of disabling spasticity on health status, individual preferences and treatment goals, tolerance for adverse events, and burden on caregivers. The pathway emphasizes a patient-centered, individualized approach and the need for interdisciplinary coordination of care, patient involvement in goal setting, and the use of assessment and outcome measures that lend themselves to practical application in the clinic. The clinical care pathway is intended for use by health care professionals who provide care for persons with SCD and disabling spasticity in various settings. Barriers to optimal spasticity management in these people are also discussed. There is an urgent need for the clinical community to clarify and overcome barriers (knowledge-based, organizational, health system) to optimizing the management of spasticity in people with SCD.


Assuntos
Tomada de Decisão Clínica/métodos , Procedimentos Clínicos , Avaliação da Deficiência , Espasticidade Muscular/diagnóstico , Traumatismos da Medula Espinal/complicações , Humanos , Espasticidade Muscular/etiologia
3.
Neuromodulation ; 19(6): 616-22, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27434115

RESUMO

INTRODUCTION: Intrathecal baclofen (ITB) screening assesses response to a test dose of ITB on spasticity and function and identifies adverse reactions. METHOD: An expert panel consulted on best practices after conducting an extensive literature search and conducting an online survey. RESULTS: A successful trial may confirm predetermined goals, which may include improved mobility/positioning, decreased time/improved independence for activities, less home exercise, better wheelchair tolerance, decreased caregiver time, improved sleep, and reduced pain, or may modify goals and expectations. Individuals should not be tested in the presence of active medical issues (e.g., MS exacerbations, active urinary tract infection, nonhealing wounds). Oral antispasmodics can be weaned before trial if a goal is to eliminate them. The standard baclofen test dose is a 50-mcg bolus, 25 mcg in very small children or patients who rely on spasticity for mobility. Patients unresponsive to the standard dose may require 75 mcg or 100 mcg; 24 hours should elapse between bolus doses. Cardiopulmonary parameters should be checked frequently during the first two hours postinjection, and spasticity measures assessed at least twice within four hours. Observation continues until the patient is stable and recovers from hypertonia. Adverse events include spinal headaches, nausea/vomiting, urinary retention, hypotension, seizures, drowsiness/sedation, respiratory depression, and coma. Before implantation, team members must discuss starting dose, drug concentration, delivery mode, pump size and location, and catheter tip placement. Patients/caregivers should understand the commitment necessary for ITB therapy. CONCLUSIONS: Screening helps identify appropriate candidates for ITB.


Assuntos
Baclofeno/administração & dosagem , Injeções Espinhais , Programas de Rastreamento/normas , Relaxantes Musculares Centrais/administração & dosagem , Espasticidade Muscular/tratamento farmacológico , Guias de Prática Clínica como Assunto/normas , Humanos , Programas de Rastreamento/métodos
4.
J Spinal Cord Med ; 31(1): 97-102, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18533419

RESUMO

BACKGROUND/OBJECTIVE: Reports in the literature suggest that administration of intrathecal baclofen to control spasticity may have deleterious effects on erectile function in men with spinal cord injury (SCI). A prospective study was conducted to document any changes in perceived sexual function after implant of a baclofen pump. METHODS: Seven adult men with SCI (ASIA A or B) who received intrathecal baclofen through an implantable pump for treatment of severe spasticity were followed for an average of 670 days (22.4 months) after implant. Perceived sexual function was assessed using the Brief Sexual Function Inventory. Severity of spasticity and overall health-related quality of life were also assessed. RESULTS: Participants reported improvements in spasticity severity and overall health-related quality of life. Two of 7 participants reported some negative changes in perceived sexual function after baclofen pump implant, noted in the areas of reduced sex drive and problems with erections (frequency, rigidity, difficulty in achieving). However, most participants reported minimal effects on sexual function, and 2 participants reported marked improvement in perceived sexual function from pre- to post-implant. Analysis of changes in perceived sexual function over time suggest that problems may be associated with an increase in baclofen dose and may be reversible with a reduction in dose. CONCLUSIONS: Intrathecal baclofen may impact perceived sexual function particularly at higher doses. However, the effects seem to be reversible with withdrawal or reduction of baclofen administration.


Assuntos
Baclofeno/efeitos adversos , Disfunção Erétil/induzido quimicamente , Disfunção Erétil/psicologia , Relaxantes Musculares Centrais/efeitos adversos , Espasticidade Muscular/etiologia , Traumatismos da Medula Espinal/complicações , Adulto , Inquéritos Epidemiológicos , Humanos , Bombas de Infusão Implantáveis , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/tratamento farmacológico , Qualidade de Vida , Fatores de Tempo
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