2019 Sidney Licht lecture: Spasticity and related neuro-orthopedic deformities: A core topic in physical and rehabilitation medicine

Abstract

Neuro-orthopedics refers to limb and spine deformities related to various neurological diseases, mostly in a context of spastic disorders. Physical and rehabilitation medicine (PRM) specialists are familiar with these deformities that often lead to functional consequences. It is crucial in our specialty to focus on their prevention and management. A better understanding of the musculoskeletal and neurological physiopathology underlying these phenomena has enabled physicians to improve their prevention and treatment approaches. The clinical assessment of spastic and neuro-orthopedic deformities, based on a rigorous anatomical and physiological knowledge, is deeply rooted in our PRM clinical examination. The evaluation of their functional consequences relies on a patient-centered approach including detailed analysis of gait and upper limb function. There is an increased relevance of motor nerve blocks, dynamic electromyography, and motion analysis in these indications. The treatment of spasticity and its sequelae is emblematic of PRM care due to an integrative multimodal approach including rehabilitation, pharmacological treatments, local management like botulinum toxin injections, and microinvasive or conventional surgery in a multidisciplinary perspective. Finally, spasticity and neuro-orthopedics represent an incredible field of research for the future of PRM, covering basic science, nonpharmacological and pharmacological studies, surgical procedure improvements, and technological developments (neuromodulation, functional electrical stimulation, and robotics).