Rozina Bhimani

Clinical measurement of limb spasticity in adults: state of the science.

ABSTRACT Spasticity is a neuromuscular dysfunction characterized by tight or stiff muscles. Spasticity occurs across the spectrum of upper motor neuron disease and complicates the course and quality of life of those affected. Accurate and precise assessment of spasticity is the first step in providing safe and effective treatments to patients for management of spasticity. Examiner evaluations (Ashworth Scale, Modified Ashworth, and Visual Analog Scale) and patient self-reports (Visual Analog Scale and Numeric Rating Scale) are used to assess spasticity in clinical practice. We reviewed the biology of spasticity and summarized research that assessed properties of scores obtained from clinical scales when used in a variety of upper motor neuron diseases. The definition of spasticity was inconsistent. Rater reliability or agreement on clinical scales varied widely. Correspondence with electromyogram results was mixed. There was dissimilarity in patient reports and examiner assessments. Scores from clinical scales are responsive (decrease after initiation of treatment with known effectiveness), but the utility of scores for indexing individual change associated with the natural history of upper motor neuron disease is unknown. Future research incorporating patient reports and examiner findings over time will help to clarify the definition and capture the essence of spasticity.

Intrathecal baclofen therapy in adults and guideline for clinical nursing care.

&NA; Advancements in healthcare technology for patients with spasticity are promising. Nurses are expected to be well‐versed in the use of technology to provide individualized and safe care. The focus of this article is on the current nursing care of patients who use technology such as intrathecal baclofen pumps to manage spasticity. Three phases of intrathecal baclofen therapy and concurrent clinical nursing care are outlined. A fundamental understanding of the intrathecal baclofen pump allows nurses to provide cutting‐edge technological and individualized care with compassion.

Clinical Understanding of Spasticity: Implications for Practice

Spasticity is a poorly understood phenomenon. The aim of this paper is to understand the effect of spasticity on daily life and identify bedside strategies that enhance patients function and improve comfort. Spasticity and clonus result from an upper motor neuron lesion that disinhibits the tendon stretch reflex; however, they are differentiated in the fact that spasticity results in a velocity dependent tightness of muscle whereas clonus results in uncontrollable jerks of the muscle. Clinical strategies that address function and comfort are paramount. This is a secondary content analysis using a qualitative research design. Adults experiencing spasticity associated with neuromuscular disorder were asked to participate during inpatient acute rehabilitation. They were asked to complete a semistructured interview to explain and describe the nature of their experienced spasticity on daily basis. Spasticity affects activities of daily living, function, and mobility. Undertreated spasticity can lead to pain, immobility, and risk of falls. There were missed opportunities to adequately care for patients with spasticity. Bedside care strategies identified by patients with spasticity are outlined. Uses of alternative therapies in conjunction with medications are needed to better manage spasticity. Patient reports on spasticity are important and should be part of clinical evaluation and practice.

Caregiving Experiences of Family Members of Persons With Dementia in South India

This study reports on the first phase of an investigation aimed at adapting The Savvy Caregiver program, a successful family caregiving curriculum developed in the United States, for application in South India. Thirty family members caring for a person with dementia were interviewed regarding their experiences as caregivers (CGs). Qualitative interviews were conducted with the family member at a geriatric clinic, while other diagnostic procedures were being carried out with the person with dementia. Findings from the study revealed that although family members understood the term CG, none could identify a word for CG in his or her language. There was little understanding of dementia as an illness. Family CGs reported feeling distressed, overwhelmed, and frustrated with caregiving. Caregivers were interested in an educational program, but many had unrealistic expectations for what they wanted to learn. The findings provide directions for adapting The Savvy Caregiver curriculum for Indian family CGs.

Spasticity over time during acute rehabilitation: a study of patient and clinician scores.

AIMS The aims of this study were to describe spasticity trajectories as a function of time, gender, and diagnosis and to explore the correspondence between patient and clinician scores of spasticity. BACKGROUND Discrepancy between examiner assessment and patient rating of spasticity exists. Assessments that include the patient perspective are critical for patient safety. This mixed-method study provided patient descriptors of spasticity integrated with clinical scales. METHOD Twenty-three participants provided spasticity descriptors and rated their spasticity based on Numeric Rating Scale (NRS) scores. A clinician evaluated spasticity daily using the Modified Ashworth Scale (MAS). This resulted in 1976 points of data for analysis. RESULTS Spasticity was highly variable over time. The empirical correspondence between the clinician-rated MAS and the patient-rated NRS revealed that patient and examiner understanding of spasticity were diverged considerably. CONCLUSIONS Clinical evaluation protocols should include patient reports on spasticity. Knowledge about patient word choice can enhance patient-provider communication.

Understanding Work‐related Musculoskeletal Injuries in Rehabilitation from a Nursing Perspective

Purpose: The incidence and prevalence of work‐related musculoskeletal nursing injuries is a top concern for nurses. These injuries are thought to be a dynamic interplay of multiple factors. A literature review reveals a knowledge gap in understanding context‐specific patterns of nursing injuries. Design: Using a cross‐sectional descriptive research design, 58 rehabilitation nurses participated in this study. Methods: Anonymous paper surveys were sent to all rehabilitation nursing personnel on the unit. Findings: Six themes emerged: lack of time and help, patient acuity, ergonomics, body movement issues, knowledge deficit, and communication. Conclusions: Nursing input is critical in understanding and reducing context‐specific work‐related musculoskeletal injuries. Further research that includes nursing voices is advocated. Clinical Relevance: Rehabilitation nursing injuries appear to be a complex interaction of multiple determinants; therefore, multifaceted solutions using a quality improvement lens are recommended to improve the working conditions on the units.

Lived Experiences of Muscle Tightness Symptoms from Patients' Perspectives

ABSTRACT The aims of this study were to understand symptoms of chronic muscle tightness from the patient’s perspective and explore symptom management strategies used by them. Muscle tightness, a common symptom, is a challenge to manage in clinical practice because it is commingled with other orthopedic conditions. Nurses may not be aware of the negative impact of tight muscles because this symptom is presumed to be self-limiting; however, if not treated appropriately, muscle tightness can become chronic. The focus of this study is the lived experience of patients with chronic muscle tightness. The researchers used a qualitative descriptive design in which patients provided insights into the experiences and self-management of chronic muscle tightness. Sixteen adult subjects experiencing physical impairments who were managed by physical therapists in a specialty clinic participated in the study. The subjects participated in 45- to 60-minute semistructured interviews to provide understanding of chronic muscle tightness. The interviews were recorded and transcribed for content analysis. Results indicate that patients identify day-to-day experiences of chronic muscle tightness as unresolving; these patients experience myriads of sensations and live with life restrictions that negatively affect their quality of life. Uses of complementary therapies are commonplace in managing this symptom. The symptom of chronic muscle tightness may linger, and patients use workarounds to manage their lives. Nurses must understand patients’ perspectives to assist them in achieving an acceptable quality of life.