Welcome to the spasticity clinic at Circle Rehabilitation. Spasticity or spastic dystonia is a muscle control disorder, in which certain muscles are continuously contracted, and spasm involuntarily. It can affect speech and movement, and interfere with your sleep. It can be a painful and distressing condition, with complications including barriers to good hygiene and self-care, pressure ulcers and poor self-esteem.
At Circle we understand the impact spastic dystonia has on patients’ daily lives, and aim to provide the best possible all-round treatment to give maximum comfort and improved quality of life. Our neurorehabilitation specialist Dr Peter Tun has 20 years’ of experience at administering injections to reduce muscle contraction. We have a multidisciplinary team of two neuro-physiotherapists, a clinical psychologist, occupational therapists, speech therapists, dieticians and nutritionists to cater to patients’ every need, and state-of-the-art rehabilitation equipment to help patients achieve better stability standing and walking, and to enable exercise in a safe and supportive environment.
The procedure clinic for injections is held on Saturday mornings (9-12am). Pre-procedure introduction, assessment, informed consent/agreement and treatment planning could take place, ideally in the presence of a neuro-physiotherapist, a week before the procedure on Friday evening 5.30-7.30pm, or Saturday morning 8-9am as required.
Dr Peter Khin Tun (MBBS 1981, MRCP UK London 1997) is a graduate of the University of Medicine (1), Yangon, Myanmar, and a Member of the Royal College of Physicians and the British Society of Rehabilitation Medicine. He has 20 years’ experience in neurological rehabilitation medicine as a staff physician and an associate specialist in UK NHS hospitals, with a special interest in multidisciplinary muscle spasticity management.
Neurological psychologist Rachel Howes qualified in 2005 from Oxford Brookes University and gained a Band 6 post in Neurology at Chase Farm Hospital Barnet. She has also worked in elderly care, a renal unit and other departments at Imperial College Healthcare NHS Trust, and with neurological patients in the community, promoting their independence.
Emily Buckle qualified as a physiotherapist from Southampton University in 2010 and her first senior role was at University Hospitals Bristol NHS Foundation Trust in 2012. Her interest in neurological rehabilitation led her to work in the community, where she specialised in stroke and traumatic brain injuries.
What is spasticity or spastic dystonia?
A muscle is never completely at rest. A continuous partial contraction gives it “tone”, which in turn helps maintain posture and prepares the muscle for active work. Following an injury to the brain or spinal cord, tension in a muscle or group of muscles can increase, leading to stiffness or uncontrollable contractions. Over time the muscles and soft tissues shorten. When this happens, it may be difficult to straighten or hold the affected limb in a normal position – this is called spasticity or spastic dystonia.
Who may be affected by spastic dystonia?
Rarely, the cause of spasticity cannot be established. It is often seen as one of the symptoms of an underlying disease or condition. About one third of stroke patients and 60% of multiple sclerosis patients develop a degree of spasticity. Other sufferers include those with cerebral palsy, Parkinson’s disease or brain/spinal cord trauma.
How is spasticity treated?
Management of spasticity is complex and requires a multidisciplinary team. The core of any treatment is the stretching and correct positioning of the limb that is prone to spasms. Treatment also can include injections of a paralysing toxin into affected muscles every 3-6 months as part of a co-ordinated approach.
Dr Tun uses muscle relaxant tablets, multiple injections to upper and/or lower limb muscles, manages neuropathic and musculoskeletal pain and gives nutritional advice, followed by prescriptions for physiotherapy, occupational therapy and forearm-wrist-hand splinting or knee-ankle-foot orthosis if required. Selected patients may be referred for functional electrical stimulation for foot-drop, spinal Intrathecal Baclofen pump assessment and insertion or to consultant hand or foot orthopaedic surgeons for examination and manipulation under anaesthesia, corrective tendon release or joint fusion surgery.
Injections into the muscle (single or multiple) are directed at spasms that cause a specific functional problem. Used appropriately in the early stages of rehabilitation, injections may deliver long-term gains in people with sudden onset neurological conditions such as stroke, stopping the brain from forgetting how to use a limb and assisting neurological recovery. Without effective spasticity management there will be prolonged effects on parts of the body, such as flexed knees, clenched fingers or clawed toes. This will lead to poor lying & sitting posture, poor hygiene, and very high risk of skin pressure sores, which are difficult to heal, requiring many months of treatment (costing up to £ 11,000).
What are the goals of spasticity treatment?
Some typical goals in the treatment of spasticity are pain relief; a decrease in the frequency of muscle spasms; improved mobility and dexterity, and improved capability at activities, from eating and drinking, and washing and dressing, to sexual activity; a decreased burden on carers and a prevention of deformity. Sometimes injections will intentionally leave some muscles to spasm so that the patient can maintain function, for example to stand up or hold an implement. With Dr Tun’s treatment and support, patients who faced having to give up their job because of their condition have been able to keep working for 5-10 years.
Why is treatment at Circle Rehabilitation unique?
For Dr Tun, talking to and reassuring patients who are often very scared about the effects of spastic dystonia is key. He is hugely experienced at treating the condition, having started injecting patients in 1997. He has been running three spasticity clinics a week for NHS patients with a turnover of 400 patients a year.
Circle Rehabilitation has an extensive, multidisciplinary team of therapists including occupational therapists, speech therapists and dieticians alongside neuro physiotherapists. The facility’s location inside an elective hospital means that patients have access to a network of consultants to refer to in the event of complications or to address any related conditions. It has a range of state-of-the-art machines, including the LiteGait, to help patients achieve a stable standing and gait, and the Hydro Physio aquatic treadmill, allowing exercises while the limbs and joints are buoyed by water.
Circle Rehabilitation allows more time for treatment and care than other medical settings. EMG and Ultrasound guidance to locate the right muscles to inject can be used for difficult muscles in the arms or legs.