Morgan Drew

#PT582 #CC In certain situations, ultrasound could be used. While evidence may not clearly supports its healing effects, if the patient believes it provides them with relief, then we could provide that modality as long as it is not the only part of their treatment.

#PT582 #AJ NMES can be used to prevent shoulder subluxation especially poststroke in the acute phases, it does not seem to support long term prevention without continued treatment. Strengthening exercises should be used in combination with this treatment for long term benefits.

@RyanOli22855873 #RO #PT582 Ryan that's a good question, but I think l physically they would be ready because this stimulation is improving ROM, not necessarily strength. Strength would be a more gradual progression. Therefore, physically, they would not be putting too much strain on their body.

@MorganDrew16 Do you think using stim and PNF in the beginning of treatment is too advanced for patients (too stimulating; both emotional and physical), if so, how could you accomplish the same success as seen in the article?

#PT582 #RO The following article demonstrates that FES in combination with PNF is beneficial for patients in improving ROM. However, over time the benefits seem to decrease. Therefore, FES could be used at the start of treatment, but not for long term. pubmed.ncbi.nlm.nih.gov/22151126/

@JordynMaxwell2 #JM #PT582 I would imagine that postural stability would improve and a reduced fall risk because if a person's sensations are more intact, they may be able to better respond to stimuli and thereby recover faster and catch themselves before falling.

@MorganDrew16 Great article, Morgan! This review did not specifically include research looking at fall prevention or postural instability as treatment outcomes. Do you think a study looking at these parameters would also show improvement with an estim intervention? #PT582 #JM

Looking forward to tonight’s twitter discussion! #PT582 #JM #TwitterThursday Here is my question:

Creatine supplementation should be avoided by patients who have preexisting renal disease. Taking supplements can raise creatinine levels, which is a waste product of muscle activity, and could worsen a patient’s condition. #PT582 #KD pubmed.ncbi.nlm.nih.gov/15273072/

As a PT, I will the APTA Health Promotion and Wellness Council, which will provide me with the tools to educate patients. Also I will direct patients to available resources, such as the CDC, to provide suggestions on living a healthier lifestyle. #PT582 #RT

Thank you to all participated and joined in on the conversation about Botulinum toxin last Thursday. Below is a summary of our discussion. #PT582 #MD

@Dmbrockman @Dmbrockman Agreed, it allows for quicker progress, but how long do you think a person should do this? At what point would you say that enough progress has been made to no longer need injections or do you think a patient should get them throughout his/her life? #PT582 #MD

Botox, while temporary, could be beneficial because the reduction of symptoms could allow us to make progress with the patient quicker than if they did not have the botox. This could allow for more progress in a shorter amount of time than usual. #PT582 #MD

@SterrettCarolyn I forgot to add #PT582 #MD to my last comment. :)

#PT582 #MD I have seen Botox used to great affect with patients with contractures. It is usually not the first line of treatment so I feel the risks are weighed against the rewards already. Although, this treatment is temporary, we combine with PT to attempt longer adaptations.

@RyanOli22855873 I think, especially for children, stimulating the gait control theory would be a great idea. This way if thye have to have more than 1 injection, they are not scared of it the following time. #PT582 #MD

@MorganDrew16 I would also try stimulating the gate control theory to supply sensory overload to see if that helped combat the pain they were experiencing prior to guidance on injections (these would be last resort).

#PT582 #MD Botox has been shown to relax the hyperactive muscles further decreasing that muscles tightness. However, due to the temporary relief of this intervention, I think seeking professional help prior to injections/medication would be more beneficial.

@DanielleAngulo4 @DanielleAngulo4 I agree! Since botox allows for such a quick improvement in spasticity, do you think that it could cause patients to be less satisfied with the results from exercise interventions, if the results from exercise do not seem as immediate? #PT582 #MD

Only the pt can decide if using botox is worth the cost/short time of effectiveness. Evaluation of their own benefits/side effects needs careful consideration. The temporary weakness might be worth the decreased spasticity and improved movement #PT582 #MD rchsd.org/programs-servi…

@SterrettCarolyn @SterrettCarolyn I agree that it is a great modality to be used for patients with contractures! Do you think that botox, like medication, for some patients could also be used too frequently and cause an overreliance on botox and lead to less effort towards other interventions?

@AlexJacobs_SPT @AlexJacobs_SPT That is a great article find! Your article also mentioned that it seems to be more effective when injected in children at younger ages; do you think that botox could cause harm to the development of the child? #PT582 #MD

#PT582 #MD While the muscular tone effects of botox for CP may only last 3-6 months, there can be long-term effects with gross motor function! Allowing the children to experience the motion with lower tone may increase the children's motivation when the botox wears off!

@ds_DPT Agreed! Some studies have shown that atrophy occurs after botox, so strengthening exercises would be important. Multani et al. Toxin in the Management of Children with Cerebral Palsy. Paediatr Drugs. doi:10.1007/s40272-019-00344-8 #PT582 #MD

@MorganDrew16 Any intervention that works to encourage functional movement would be recommended. These could be immobilizing with splinting or casting, or work on movement specific aspects with general movement training or strengthening exercises. #PT582 #MD

#PT582 #MD Some modalities, although temporary, can briefly alleviate pathologies long enough for longer lasting interventions to be used. In this case an item such as botox is immensely useful in providing that initial stepping stone to build off of.

@abigail_lue I agree! I think that it is definitely patient dependent and important to see how the patient responds to the botox intervention. #PT582 #MD

@MorganDrew16 In this study pts received tx over a range of 27-48 months but, I think I would depend on the severity of impairment. If the pt was seeing lasting benefits after 2-3 rounds of injections I think it would make more sense to focus on PT rather than continuing BTX-A #PT582 #MD

A retrospective study by Juneja et al. found that BTX-A combined with intensive therapy can provide long-term benefits for children with CP by decreasing spasticity and increasing ROM and gait #PT582 #MD

@HaydenHoekstra @HaydenHoekstra agree that if it is paired with active exercise then it can be beneficial for short term and long term purposes! Are there particular active exercises that you think would be beneficial, (ie isometric, isotonic,etc)? #PT582 #MD

#MD #PT582 I think botox is an interesting modality, and can definitely be beneficial if paired with active exercise. If we can reduce the hypertonicity for a short period and be able to correct the factors contributing to it then maybe they wont have to get botox a second time.