The topic of today's discussion is spasticity treatment after stroke, a condition affecting up to 40% of first-time stroke patients. Our guest, Dr. Samuel Milton, specializes in this treatment and offers invaluable tips to patients and therapists. According to him, spasticity treatment after stroke requires clear objectives, cautious consideration of treatment options, and proper aftercare techniques to achieve the best possible outcomes.

“What’s really important when you are looking at a treatment plan is that you want to have a goal in mind. What are you, the therapist, the patient, and caregiver, what are you trying to accomplish?”

While some patients may be eager to rush into Botox treatment, Dr. Milton advises caution and consideration of visual markers to assess the rate of return before and after the treatment.

“In this business many times you find that when patients or loved ones go through a scenario like this, they want the opposite. So if their hand is starting to close all of a sudden they say well I need Botox. But at the same time their hand is just starting to close so I may not want to jump in there and necessarily do Botox especially if their range of motion is full. Now they are starting to get some rate of return. Let’s see where that return takes us. If there is a problem, we’ll address it. I generally don’t jump on that right away.”

After a treatment is done, proper aftercare is essential to ensure the highest rate of success. Dr. Milton stresses that the type of treatment is just as important as the technique used to apply it.

“My injection technique usually after I inject, I will pretty aggressively stretch the muscle because Botox diffuses pretty readily in the muscle and I do that to help with the spread of the muscle. Really spread the muscle out as much as I can after I do an injection.”

In This Episode

Introduction (0:00)
Dr. Milton talks about his educational background, medical expertise, and work practice (01:36)
How to best describe the medical condition of spasticity to patients (03:50)
Dr. Milton elaborating on why the flexors are typically the spastic muscles (05:18)
What types of spasticity treatments are currently available? (07:37)
Medication or Botox? How to determine who gets what? (09:00)
What are the side effects for taking medication for spasticity (09:53)
Explaining what intrathecal back pumps are (11:17)
Discussing Chemo denervation techniques and botulism (13:04)
What other local injections should one consider (14:39)
What every new stroke patient should know (13:04)
What treatments do Dr. Milton’s patients prefer? (16:39)
Using electric stimulation to speed up the reaction (19:51)
Different types of injections and Botox techniques (20:58)
Funding Botox for stroke patients (27:07)
Can we achieve the breakthrough to no spasticity? (31:56)

Our Guest

Dr. Samuel Milton is a highly experienced physiatrist with over 30 years of medical practice. He received his medical degree from Harvard University College of Medicine and has been working at Emory Healthcare in Atlanta, GA for over 20 years. During his career, he has been involved in teaching academic practice with inpatient and outpatient settings, but mostly running stroke rehab units. Currently, Dr. Milton manages the inpatient stroke unit at Emory and has an outpatient practice for patients with chronic stroke deficits.

Resources & Links

Samuel Milton on LinkedIn   / samuel-milton-8a578a55  
Emory Healthcare https://providers.emoryhealthcare.org...

Henry Hoffman on LinkedIn   / henry-hoffman-01a09312  

Saebo’s Stroke Caregiver Support Group   / 423786023009376  
Saebo’s Stroke Survivor Support Group   / saebostrokesupport  

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https://www.saebo.com/stroke-exercise...

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Saebo, Inc. is a medical device company primarily engaged in the discovery, development, and commercialization of affordable and novel clinical solutions designed to improve mobility and function in individuals suffering from neurological and orthopedic conditions. With a vast network of Saebo-trained clinicians spanning six continents, Saebo has helped over 500,000 clients around the globe achieve a new level of independence.