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Accreditation Statement
AAPM&R is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

CME Credit Designation
AAPM&R designates this other activity (combination of live and on-demand sessions) for a maximum of 1.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Clinical Session Proposals

Spasticity

Session Name: Concurrent Sessions

Spasticity's Evil Cousin: Challenges to Evaluation and Management of Secondary Dystonia due to Cerebral Palsy, Stroke or Brain Injury

Saturday, November 18, 2023

10:45 AM – 12:00 PM CT

Location: CC 225-227

Session Director(s)

Daniel K. Moon, MD

Attending Physician
MossRehab Physical Medicine Associates
Elkins Park, Pennsylvania

Disclosure(s): No financial relationships to disclose

Faculty(s)

Cindy B. Ivanhoe, MD

Assistant
TIRR-Memorial Hermann
Houston, Texas

Disclosure(s): No financial relationships to disclose
Mary E. Russell, DO

Assistant Professor; Vice Chair Quality & Compliance UTH TMC; Medical Director
University of Texas McGovern Medical School; TIRR Memorial Hermann
Magnolia, Texas

Disclosure(s): Abbvie: Consultant/Advisory Board (Ongoing); Merz: Speaker/Honoraria (Ongoing)
Kelly Crawford, MD

Residency Program Director, Brain Injury Program Director
Carolinas Rehabilitation
Charlotte, North Carolina

Disclosure(s): No financial relationships to disclose

Session Description: Secondary dystonia can occur as a sequela of cerebral palsy, stroke or brain injury and be very physically and psychologically debilitating. Although it is often misdiagnosed as or included under spasticity, it has several distinguishing features. Thus it also warrants a different approach to management. We will review evaluation and current evidence regarding treatment including physical modalities, pharmacologic interventions, focal injections and neuromodulation. Several challenging interactive cases will be presented to demonstrate the multidisciplinary and multifaceted team approach that may be required to help these very challenging patients.

Why is this session needed? : Secondary dystonia following central nervous system injury is likely underdiagnosed and thus underappreciated. However it warrants more recognition and should not be confused with spasticity. There are some key differences to respective evaluation and management although choice of medications and interventions overlap. Unfortunately there is a gap in evidence based medicine as much of the research has been focused on spasticity or primary dystonias. We will review the available evidence and guidelines pertaining to management of patients with secondary dystonia. Cases will also be presented to help the audience better identify and understand this potentially very debilitating condition.

Was this session previously presented at the Annual Assembly?: No

Learning Objectives:

Identify and differentiate between secondary dystonia and spasticity.
Evaluate a patient with secondary dystonia and how it affects their quality of life and function.
Develop a treatment plan including pharmacological interventions including intrathecal medications, injection therapy, physical modalities and orthoses.
Identify potential challenges and pitfalls associated with management of patients with secondary dystonia.