Pat:
It sounds like the tone is throughout his body. To manage the tone, you may
need the power of chemistry. :-)
I would start by asking for a physician to provide some level of intervention
with oral (if possible) anti spasticity medications such as Baclofen.
Hopefully, this will yield some positive changes for you and make physical
rehab more beneficial.
Good luck!
Arley Johnson, MS, OTR/L
________________________________
From: [EMAIL PROTECTED] on behalf of pat leegan
Sent: Sat 2/9/2008 2:01 PM
To: [email protected]
Subject: Re: [OTlist] falls in the home
HI,
I am a home health OTR/L working with a bilateral CVA patient (46 yrs) with
hign extensor tone upper and lower extremities. I have been using a distal to
proximal approach, as the reverse has not produced results, and have been doing
tigeminal nerve stimulation to decrease tone (which has been moderatly
sucessful).and PNF patterns D1 and D2.
I would appreciate any additional approaches from the list, that might break
this tone. He is not able to get into quadrqped, and is most often seen in
bed.He does have 1/4 finger flexion right hand and 1/4 thumb flexion right.
He has a very supportive family that are currently participating in his home
exercise progtam, which includes gentle biltateral joint mobilization and
prolonged stretching.
any suggestions would be greatly appreciated.
Peace, Pat Leegan, MS,OTR/L
Ron Carson <[EMAIL PROTECTED]> wrote:
Hello All:
Nice to finally see a little "traffic" on the OTlist.
Interestingly, I was JUST on Cochrane.org and one of their Evidence
Summaries is about preventing falls in the elderly. Given that their
information is in the public domain, I'll post it here. Of course, you
can also read it on their website.
Ron
#################################################################
Abstract
BACKGROUND:
Approximately 30 per cent of people over 65 years of age and living in
the community fall each year; the number is higher in institutions.
Although less than one fall in 10 results in a fracture, a fifth of fall
incidents require medical attention. Objectives
To assess the effects of interventions designed to reduce the incidence
of falls in elderly people (living in the community, or in institutional
or hospital care).
SEARCH STRATEGY:
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised
Register (January 2003), Cochrane Central Register of Controlled Trials
(The Cochrane Library, Issue 1, 2003), MEDLINE (1966 to February 2003),
EMBASE (1988 to 2003 Week 19), CINAHL (1982 to April 2003), The National
Research Register, Issue 2, 2003, Current Controlled Trials
(www.controlled-trials.com accessed 11 July 2003) and reference lists of
articles. No language restrictions were applied. Further trials were
identified by contact with researchers in the field.
SELECTION CRITERIA:
Randomised trials of interventions designed to minimise the effect of,
or exposure to, risk factors for falling in elderly people. Main
outcomes of interest were the number of fallers, or falls. Trials
reporting only intermediate outcomes were excluded.
DATA COLLECTION AND ANALYSIS:
Two reviewers independently assessed trial quality and extracted data.
Data were pooled using the fixed effect model where appropriate.
MAIN RESULTS:
Sixty two trials involving 21,668 people were included.
Interventions likely to be beneficial:
* Multidisciplinary, multifactorial, health/environmental risk
factor screening/intervention programmes in the community both
for an unselected population of older people (4 trials, 1651
participants, pooled RR 0.73, 95%CI 0.63 to 0.85), and for older
people with a history of falling or selected because of known
risk factors (5 trials, 1176 participants, pooled RR 0.86, 95%CI
0.76 to 0.98), and in residential care facilities (1 trial, 439
participants, cluster-adjusted incidence rate ratio 0.60, 95%CI
0.50 to 0.73)
* A programme of muscle strengthening and balance retraining,
individually prescribed at home by a trained health professional
(3 trials, 566 participants, pooled relative risk (RR) 0.80, 95%
confidence interval (95%CI) 0.66 to 0.98)
* Home hazard assessment and modification that is professionally
prescribed for older people with a history of falling (3 trials,
374 participants, RR 0.66, 95% CI 0.54 to 0.81)
* Withdrawal of psychotropic medication (1 trial, 93
participants, relative hazard 0.34, 95%CI 0.16 to 0.74)
* Cardiac pacing for fallers with cardioinhibitory carotid sinus
hypersensitivity (1 trial, 175 participants, WMD -5.20, 95%CI
-9.40 to -1.00)
* A 15 week Tai Chi group exercise intervention (1 trial, 200
participants, risk ratio 0.51, 95%CI 0.36 to 0.73).
Interventions of unknown effectiveness:
* Group-delivered exercise interventions (9 trials, 1387
participants)
* Individual lower limb strength training (1 trial, 222
participants)
* Nutritional supplementation (1 trial, 46 participants)
* Vitamin D supplementation, with or without calcium (3 trials,
461 participants)
* Home hazard modification in association with advice on
optimising medication (1 trial, 658 participants), or in
association with an education package on exercise and reducing
fall risk (1 trial, 3182 participants)
* Pharmacological therapy (raubasine-dihydroergocristine, 1
trial, 95 participants)
* Interventions using a cognitive/behavioural approach alone (2
trials, 145 participants)
* Home hazard modification for older people without a history of
falling (1 trial, 530 participants)
* Hormone replacement therapy (1 trial, 116 participants)
* Correction of visual deficiency (1 trial, 276 participants).
Interventions unlikely to be beneficial:
* Brisk walking in women with an upper limb fracture in the
previous two years (1 trial, 165 participants).
Authors' conclusions:
Interventions to prevent falls that are likely to be effective
are now available; less is known about their effectiveness in
preventing fall-related injuries. Costs per fall prevented have
been established for four of the interventions and careful
economic modelling in the context of the local healthcare system
is important. Some potential interventions are of unknown
effectiveness and further research is indicated.
#######################################################################
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