A comprehensive person-centered approach to adult spastic paresis: A consensus-based framework

Lynne Turner-Stokes, Stephen Ashford, Alberto Esquenazi, Jörg Wissel, Anthony B. Ward, Gerard Francisco, Jorge Lains, Areerat Suputtitada, Simão Serrano, Ian J. Baguley, Michael Barnes, David M. Simpson

Research output: Contribution to journalArticle

Abstract

Spastic paresis is a common feature of an upper motor neuron impairment caused by stroke, brain injury, multiple sclerosis and other central nervous system (CNS) disorders. Existing national and international guidelines for the treatment of adult spastic paresis tend to focus on the treatment of muscle overactivity rather than the comprehensive approach to care, which may require life-long management. Person-centered care is increasingly adopted by healthcare systems in a shift of focus from "disease-oriented" towards "person-centered" medicine. The challenge is to apply this principle to the complex management of spastic paresis and to include an educative process that engages care providers and patients and encourages them to participate actively in the long-term management of their own disease. To address this issue, a group of 13 international clinicians and researchers used a pragmatic top-down methodology to evaluate the evidence and to formulate and grade the strength of recommendations for applying the principles of person-centered care to the management of spastic paresis. There is a distinct lack of clinical trial evidence regarding the application of person-centered medicine to the rehabilitation setting. However, the current evidence base supports the need to ensure that treatment interventions for spastic paresis should be centered on as far as reasonable on the patient's own priorities for treatment. Goal setting, negotiation and formal recording of agreed SMART goals should be an integral part of all spasticity management programs, and goal attainment scaling should be recorded alongside other standardized measures in the evaluation of outcome. When planning interventions for spastic paresis, the team should consider the patient and their family's capacity for self-rehabilitation, as well as ways to enhance this approach. Finally, the proposed intervention and treatment goals should consider the impact of any neuropsychological, cognitive and behavioral deficits on rehabilitation. These recommendations support a person-centric focus in the management of spastic paresis.

LanguageEnglish
Pages605-617
Number of pages13
JournalEuropean Journal of Physical and Rehabilitation Medicine
Volume54
Issue number4
DOIs
StatePublished - Aug 1 2018

Fingerprint

Muscle Spasticity
Paresis
Consensus
Rehabilitation
Medicine
Therapeutics
Central Nervous System Diseases
Negotiating
Motor Neurons
Brain Injuries
Multiple Sclerosis
Patient Care
Stroke
Research Personnel
Clinical Trials
Guidelines
Delivery of Health Care
Muscles

Keywords

  • Consensus
  • Muscle spasticity
  • Person-centered therapy
  • Rehabilitation
  • Self-management
  • Spastic paraparesis

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

Cite this

Turner-Stokes, L., Ashford, S., Esquenazi, A., Wissel, J., Ward, A. B., Francisco, G., ... Simpson, D. M. (2018). A comprehensive person-centered approach to adult spastic paresis: A consensus-based framework. European Journal of Physical and Rehabilitation Medicine, 54(4), 605-617. https://doi.org/10.23736/S1973-9087.17.04808-0

A comprehensive person-centered approach to adult spastic paresis : A consensus-based framework. / Turner-Stokes, Lynne; Ashford, Stephen; Esquenazi, Alberto; Wissel, Jörg; Ward, Anthony B.; Francisco, Gerard; Lains, Jorge; Suputtitada, Areerat; Serrano, Simão; Baguley, Ian J.; Barnes, Michael; Simpson, David M.

In: European Journal of Physical and Rehabilitation Medicine, Vol. 54, No. 4, 01.08.2018, p. 605-617.

Research output: Contribution to journalArticle

Turner-Stokes, L, Ashford, S, Esquenazi, A, Wissel, J, Ward, AB, Francisco, G, Lains, J, Suputtitada, A, Serrano, S, Baguley, IJ, Barnes, M & Simpson, DM 2018, 'A comprehensive person-centered approach to adult spastic paresis: A consensus-based framework' European Journal of Physical and Rehabilitation Medicine, vol. 54, no. 4, pp. 605-617. https://doi.org/10.23736/S1973-9087.17.04808-0
Turner-Stokes, Lynne ; Ashford, Stephen ; Esquenazi, Alberto ; Wissel, Jörg ; Ward, Anthony B. ; Francisco, Gerard ; Lains, Jorge ; Suputtitada, Areerat ; Serrano, Simão ; Baguley, Ian J. ; Barnes, Michael ; Simpson, David M. / A comprehensive person-centered approach to adult spastic paresis : A consensus-based framework. In: European Journal of Physical and Rehabilitation Medicine. 2018 ; Vol. 54, No. 4. pp. 605-617.
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