Specialist team

Medical

Usually a rehabilitation medicine physician, geriatrician or neurologist. They have expert knowledge of the following:

• Pathophysiology of spasticity.
• Exacerbating factors and how to treat them.
• Pharmacology of oral and local agents to treat spasticity.
• The role of other specialists such as orthopaedic surgeons in managing hypertonia.
• The licencing and regulation of Botulinum Toxin and other advanced techniques.
• The skills to deliver focal antispasmodic treatment for example identifying muscles for injection.
• Skills to lead an integrated specialist team.

Specialist nurse

A nurse with expertise in assessment, treatment and management of spasticity. They may have a particular interest in identifying and managing trigger factors for spasticity and providing information and education to assist the patient in self management of spasticity. In some centres a specialist nurse may provide targeted treatment with Botulinum Toxin and may be able to provide advice about medication management.

Physiotherapy

The role of the specialist physiotherapist is to assess movement following stroke and the effect spasticity may be having on this movement. The physiotherapist will be experienced in identifying which muscles are involved and how best to treat them. For example, if there is subluxation at the shoulder, then care should be taken when when injecting biceps as the long head of biceps also acts as a shoulder stabiliser. The physiotherapist is also involved in self management of spasticity including stretches, splinting and positioning and in rehabilitation following spasticity treatment to encourage normal patterns of movement and mobility to develop.

Orthotist

Specialist in the assessment of the whole body for biomechanical problems and if appropriate may prescribe, measure, fit or review an orthosis. An orthosis may also be called a “brace”, “splint” or “orthotic”. The purpose and design of an orthosis may change over time along with the changing needs of the patient.

Spasticity services use a combined management strategy for each individual patient. Some treatments will occur in sequence to maximise the patients function for example physiotherapy and orthotists will work together to achieve joint mobility and stretch before an orthosis is made. Medical staff may change oral medication before a trial of Botulinum Toxin injections and the specialist nurse will monitor functional changes or side effects.