Looking for a spasticity clinic?

Use these tips to evaluate providers

Most case managers understand the importance of a team approach to disability management and life care planning. Finding a clinic that makes use of a multidisciplinary team to evaluate and treat spasticity management is essential to a good outcome, stress professionals interviewed by Case Management Advisor.

LuRae Ahrendt, RN, CRRN, CCM, a rehabilitation nurse consultant with Ahrendt Rehabilitation in Norcross, GA, says she looks for a spasticity clinic that uses the following professionals to evaluate and treat patients with spasticity:

• physiatrists;

• orthopedists;

• neurologists;

• physical therapists;

• occupational therapists;

• speech therapists;

• nurses.

"The approach of the team to spasticity is also important," notes Alan M. Harben, MD, assistant professor of physical medicine and rehabilitation at The Emory Clinic in Atlanta. "Spasticity management must always be focused on specific functional goals, such as improvements to positioning, hygiene, or activities of daily living."

"For example, physiatrists look at patients from a functional perspective and are well-suited to oversee spasticity management," says Harben. "However, you must have a physiatrist who is willing to refer to other medical specialists, such as a neurologist for a pump implant, or an orthopedist for surgery, in a timely and appropriate manner," he cautions.

Hitting the road

The clinic's therapists should also be willing to evaluate patients in their own environment, argue Harben and Ahrendt. "I can think of several cases where we would have missed specific problems with activities of daily living if we had evaluated the patient in the clinic and not in the home," notes Harben. "If the evaluation is done in the home, the therapist can also look at the need for adaptive aids or home modifications at the same time," he adds. (For a detailed discussion of functional evaluation and home modifications, see CMA, August 1996, pp. 101-113.)

Barbara Weissman, MD, a neurologist and medical director of Egleston Children's Rehabilitation Center in Atlanta, also stresses the importance of a team approach to spasticity management. "It's useful when dealing with pediatric patients to have the various professionals in the clinic at the same time and observe each other evaluate the child. With a child, there is a real danger of suggesting a surgery or treatment that won't achieve the desired effect because of the child's developmental stage. It helps me, for example, to have an orthopedist present, who can say, 'The child is at this stage and about to have a growth spurt. If we do this procedure too early, it won't be helpful,'" explains Weissman. She also suggests that case managers working with pediatric patients look for clinics willing to thoroughly evaluate and clearly educate both the patient and the family before anything is done to the child.

Pull out the entire tool chest

A good spasticity clinic also will offer a wide variety of treatment modalities, Harben adds. (For further discussion of treatment options, see the cover story.) "Don't refer patients to a clinic that recommends one treatment for all patients. For spasticity management, you must avoid clinics that see one pet treatment as the hammer and spasticity management as the nail," he cautions. "A good clinic will have an entire tool chest and find the tool that works best to meet your patient's specific needs."

"It's also clear that not all areas of the country have the benefit of a good spasticity clinic," notes Ahrendt. "If you are bringing a patient into a clinic from a great distance, you should make contact with the clinic coordinator or medical director before bringing the patient in for a consultation," she recommends.

Ahrendt suggests case managers discuss the following areas with the clinic coordinator or medical director:

• the case manager's functional goals for the patient;

• any preliminary steps or evaluations that should be taken or performed before bringing the patient to the clinic;

• the clinic's willingness to provide a long-term treatment plan for the local treatment team to follow;

• the clinic's willingness to support, coordinate, and advise the local treatment team.

"Our team will always formulate a 24-hour plan that can be used in the community on a long-term basis. We also give the local team a set of parameters to follow, so they know at what point it might be necessary to refer back to the clinic," notes Harben, who manages The Emory Clinic's spasticity program.