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Providing Relief for Patients With Spasticity

Tuesday, May 14, 2019 1:17 PM

NorthShore's Physical Medicine & Rehabilitation services offer comprehensive treatment strategies for patients with functional disorders. At NorthShore, the doctors are trained to treat patients holistically and to synthesize how different body systems interact to function optimally. Dr. Rachel Kermen, Physical Medicine & Rehabilitation, helped us understand what goes into the treatment of Spasticity, a disorder that can impair function and limit a patient’s ability to engage in everyday activities. 

dr helping with knee

What led you into Physical Medicine and Rehabilitation?

I started medical school with plans to become a neurologist, after nearly pursuing a career studying cognition in marine mammals. However, after delving into my cadaver dissections as a medical student, I developed a great appreciation for the human body’s functional mechanics and anatomy, which represents an amazing feat of engineering design. Physical Medicine & Rehabilitation merges my interests in neurology and functional anatomy. Our specialty is uniquely trained to treat our patients holistically and to synthesize how different body systems interact. Our background helps us restore optimal function in patients who have suffered neurologic, orthopaedic and musculoskeletal conditions.

What kinds of patients do you treat?

Many of my patients suffer from something called spasticity. In these cases, a muscle is abnormally overactive due to a signal from the brain or spinal cord caused by a stroke, brain injury, brain tumor, cerebral palsy, multiple sclerosis or other neurologic conditions. Because of this, their arm might be constantly flexed or their leg continuously extended in a way that cannot be overcome voluntarily.

What can be done for patients with spasticity?

In patients who suffer limitations from spasticity, we try to restore a more balanced and adaptive body mechanics pattern. In particular, I utilize an FDA-approved injection treatment called botulinum toxin therapy. I also use state-of-the-art modalities including ultrasound machine technology to guide the injection. Ultrasound is a fantastic tool in both neurorehabilitation and musculoskeletal care because you can safely visualize the target anatomy in real time, right at the patient’s bedside at the time of the appointment. Patients love it; it is less invasive, quicker, and in certain cases, much more precise than other injection approaches.

Did you say toxins?

Yes! Science has harnessed the healing ability of a variety of toxins and transformed them into medicine. One of these you’ve probably heard of is OnabotulinumtoxinA or Botox. I also use FDA-approved sister medications including Dysport and Xeomin. Injecting these medications into the overactive spastic muscles causes them to relax, which can restore a more normal balance in muscle tone and promote a patient’s ability to engage in activities that are personally important.

What is the most rewarding part of your job?

I want patients to receive state-of-the-art care for conditions that are disabling with a particular focus in my practice on spasticity care, which is often an under-recognized condition by medical providers. I also recognize that sometimes simple improvements can make a key difference in a patient’s ability to function and achieve personal goals.

I had a patient who could not walk without a heavy and cumbersome leg brace. After Botox injections and therapy treatment, the patient’s muscle tone was improved enough to walk confidently without the brace. I’ve also treated elite competitive athletes whose spasticity might not have caused impairment in someone else but hampered their career aspirations, with improvement in their athletic performance after Botox treatment. 

On another occasion, I had a patient with a long history of back and hip pain who had been to multiple providers over many years while no one noticed a significant leg length discrepancy. A simple low-cost heel insert was the trick to eliminate that pain. Problem-solving to determine the root cause and identify the most effective treatment strategies for my patients are the most rewarding success stories for me.

When should patients think about a referral to NorthShore’s Physical Medicine & Rehabilitation services?

If you are unsure of why you aren’t functioning well or why your body is experiencing pain, ask your primary care provider if a referral to us is the next step. We can help patients achieve their functional goals, identify the cause of pain across neurological, musculoskeletal and orthopaedic conditions, and ensure you are taking advantage of the best treatments in your recovery.