Presentations
- Active dysfunction
- Cosmetic appearance
- Pain
- Passive dysfunction
Conditions/aetiology
- Acquired brain injury
- Cerebral palsy
- Familial dystonias
- Hereditary spastic paraplegia
- Leucodystrophies
- Multiple sclerosis (MS)
- Other upper motor neurone lesions
- Spinal cord injury
- Stroke
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Biomechanical principles of joint motion control
- Biomechanics and phases of the gait cycle (to in differentiating normal from pathological patterns)
- Identification of neuromuscular pathology, including positive and negative features of upper motor neurone (UMN) syndrome, urophysiology of spasticity including inhibitory/excitatory pathways and relevant neurotransmitters
- Normal limb, brain and vertebral anatomy, and neuromuscular physiology
- Clinical gait assessment
- Functional assessment
- Outcome measures
- Relevant cognitive and psychosocial assessment
- Role of gait laboratory assessment referral
- Specific spasticity scale measures:
- Modified Ashworth Scale
- Tardieu Scale
- Targeted physical examination, including:
- musculoskeletal joint examinations
- neurological limb examination
- Use of goniometer for joint assessments
Activity
- 10-metre walk test
- Arm activity measure (ARM A)
- Six-minute walk test
- Timed up and go
- Upper limb scales of the motor assessment scale (UL-MAS)
Impairment
- Muscle strength antidepressants
- Pain scales
- Range of movement (ROM)
Participation
- Assessment of quality of life (AQOL)
- Career burden scale
- Goal attainment scale/goal attainment scaling (GAS light)
- Short form health survey
Pharmacological
- α2 adrenergic agonists
- Alcohol
- Baclofen
- Benzodiazepines – clonoazepam, diazepam
- Botulinum toxin A
- Cannabinoids
- Chemical denervation
- Clonidine
- Dantrolene sodium
- Gabapentin/Pregabalin
- Gamma aminobutyric acid (GABA)
- Intrathecal
- Muscle calcium release inhibitor
- Oral
- Phenol
- Tizanidine
Physical interventions
- Botulinum toxin injection guidance options – electromyography (EMG), muscle electrical stimulation, skin landmarks and ranging, and ultrasound
- Electrical stimulation – functional electrical stimulation (FES), TENS
- Muscle strengthening
- Positioning – wheelchair supports, orthoses
- Temperature/heat cryotherapy
Reduction/prevention of noxious stimuli (including but not limited to)
- Bladder – infections
- Bowel – constipation, fissure, haemorrhoids
- Fatigue
- Fractures
- Pain
- Skin problems – infections, pressure wounds
- Temperature extremes
Surgical
- Arthrodesis
- Highly selective neurotomies
- Neurostimulation
- Neurosurgical
- Orthopaedic
- Selective dorsal root rizotomy
- Tendon lengthening
- Tendon transfer
- Tenotomy
