Rehabilitation Medicine Specialists Research Articles

Comparative analysis of Kinesio taping and dry-needling: effects on pain and disability in patients with mechanical low back pain

Background & Objective: Low back pain (LBP) is an ever-increasing menace in the young men as well as women. Many factors causing it have been identified, the most common being improper spinal posture. LBP has been targeted by physicians, anesthetists, surgeons and rehabilitation medicine specialists. We compared the effects of Kinesio Taping and dry needling on pain reduction and disability improvement in patients diagnosed with mechanical chronic LBP. Method: A randomized control trial (RCT) was conducted at Rawal General and Dental Hospital and Al-Nafees hospital in Islamabad from January 2020 to October 2021. Probability-based sampling method was used to select participants for the study (simple random sampling). Thirty patients, aged 18 to 75 y were included. Sample size was calculated with Epitools. The selected patients were divided in two groups i.e., 15 patients in the Kinesio taping group (KT group) and 15 in the dry needling group (DN group). Two patients in the needling group were dropped. Numeric Pain Rating Scale (NPRS) and Roland-Morris Disability Index Questionnaire (RMDQ) were used to assess the pain and the disability at baseline, two weeks post-intervention and four weeks post-treatment. Chi-Square test was use to find association. Results: The mean age of the patients was 39.60 ± 13.69 y for KT group and 37.15 ± 12.54 y for DN group. The mean BMI for KT group was 27.15 ± 6.70 kg/m2 and for DN group 27.52 ± 5.13 kg/m2. Before treatment, there were no differences between the groups for NPRS and RMDQ. Both dry needling and Kinesio taping produced significant improvements in NPRS and RMDQ after two and four weeks of treatment (P < 0.05). However, statistical analysis results showed that there was no association between pain and disability in patient with non-specific low back pain. (P > 0.05). Conclusion: Both, Kinesio taping and dry needling, significantly reduced pain and disability after two- and four-weeks treatment in patients with low back pain, but there was no statistical differences between the pain and disability in both groups. Keywords: Disability; Dry Needling; Kinesio Tape; Low Back Pain; Numeric Pain Rating Scale; Physiotherapy Citation: Asad A, Irshad A, Hassan T, Kiran Q, Kouser S, Hassan F. Comparative analysis of Kinesio taping and dry-needling: effects on pain and disability in patients with mechanical low back pain. Anaesth. pain intensive care 2024;28(5):933−938; DOI: 10.35975/apic.v28i5.2561 Received: April 26, 2024; Reviewed: July 16, 2024; Accepted: July 18, 2024

The Development of a Quantitative Disability Assessment Tool in Patients with Idiopathic Parkinson's Disease.

Background/Objectives: The objective of this study was to develop a novel quantitative disability assessment tool for patients with idiopathic Parkinson's disease (IPD). Methods: A total of 47 patients with IPD were recruited from two hospitals. A specialist in Rehabilitation Medicine utilized the modified Schwab and England Activities of Daily Living Scale (mSEADL) as a reference, conducting a comprehensive medical chart review and an in-depth interview. The novel-developed disability measurement was calculated as ((mSEADL during the on-state) × (time of on-state)) + ((mSEADL during the off-state) × (time of off-state))/(waking time). Additionally, the degree of disability was assessed using the Korean version of the Modified Barthel Index during the on-state. Results: Twenty-four participants (51.1%) exhibited the off-state during waking hours. In patients exhibiting an off-state, the mSEADL score was significantly lower during the off-state than during the on-state (p < 0.05). The novel-developed disability measurement demonstrated a higher correlation coefficient with the reference mSEADL (0.960) than with the K-MBI (0.808), with statistical significance (p < 0.05). Conclusions: The results demonstrated that larger IPD patients exhibited an on-off phenomenon with greater dependency during the off-state. Therefore, the on-off phenomenon should be considered when evaluating disability in patients with IPD, with methods such as the novel-developed disability measurement tool in this study.

Developing Physiotherapy in Primary Health Care: A First Snapshot from the Italian Metropolitan City of Milan.

Since the COVID-19 pandemic, the Italian National Health Service (NHS) has been undergoing a structural reform shifting focus from hospital-centered care to smaller, intermediate, or primary health facilities closer to the community (e.g., community hospitals and community houses). This reorganization should include rehabilitation and physiotherapy, but the actual spread of these services is still unclear. This study explored the number and characteristics of community-based physiotherapy services in the Metropolitan City of Milan (Italy). Between April and May 2024, we distributed a structured, anonymous online survey about community physiotherapy services and users to all Directors of the Health and Social Care Professions Departments (DAPSS) in the Metropolitan City of Milan. We used descriptive statistics to analyze the number of community houses offering physiotherapy services, the specific intervention areas, and access modalities. Six out of seven DAPSS Directors completed the survey (87%). Thirty-seven community houses were reported in the area, with fourteen of these offering physiotherapy services. In most of them, physiotherapy was a primary reason for access following a general practitioner's prescription. Five out of six responders reported that rehabilitation needs were mainly assessed by specialists in Physical and Rehabilitation Medicine, with physiotherapists involved in the assessment process in two cases. Physiotherapists primarily handled the intervention phase, dealing mainly with orthopedic and neurological conditions. DAPSS Directors noted that additional physiotherapy initiatives focusing on prevention will be implemented. Physiotherapy services are becoming available in the Metropolitan City of Milan. However, more efforts are needed to facilitate access and ensure tailored assessment and effective interventions, particularly in preventive care. Future investigations should help to better define the number and the characteristics of the patients who can most benefit from this type of care, the number of sessions they need, and with what types of intervention; it would be also necessary to better define the communication network in the area that allows doctors, health professionals, and patients to be informed about this possibility.

Effects of baclofen administered to reduce muscle spasm on balance maintenance, gait ability and quality of life in stroke patients

This study aimed to investigate the impact of Baclofen on balance, gait, functional independence, and quality of life in ischemic stroke patients. Thirty patients diagnosed with ischemic stroke by a rehabilitation medicine specialist were randomly assigned to either an experimental group that underwent exercise therapy in conjunction with Baclofen or a control group that received conventional exercise therapy without Baclofen. In this study, Berg Balance Scale, Timed Up and Go, and 10-Meter Walk Test were used to evaluate balance and walking ability. Functional Independence Measure was employed to assess functional independence, and Stroke-Specific Quality of Life was used to evaluate the quality of life. The experimental results revealed statistically significant improvements in all evaluation measures for both groups when comparing post-test to pre-test. However, in comparisons between groups, all test items in the experimental group that combined Baclofen with exercise therapy were significantly higher than those in the control group. In conclusion, these results suggest that integrating Baclofen into exercise therapy rehabilitation programs could be a promising approach to enhance recovery outcomes for patients recovering from ischemic stroke.

Homonymous hemianopia and visual neglect: Part II ― rehabilitation

This article is the second part of a literary review of the most common and difficult to differentiate between visualspatial disorders, namely, homonymous hemianopia and unilateral spatial neglect, which occur after a right hemisphere stroke. In the first part of the review, the phenomenology of these disorders, diagnostic methods, and criteria for their difference were comprehensively explored.&#x0D; The second part highlights modern methods of rehabilitation based on the recommendations of the World Federation for Neurorehabilitation. For the rehabilitation of homonymous hemianopia, the following interventions are recommended: saccadic training, hemianopic reading training, restorative visual field training, etc. For the rehabilitation of the neglect syndrome, the following interventions are encouraged: visual scanning training, optokinetic/smooth pursuit therapy, prism adaptation, eye patching, noninvasive brain stimulation, etc.&#x0D; Recommendations on the methods and timing of their implementation are presented, and modern clinical studies are highlighted. In addition, the innovative methods of eye tracking and virtual reality are described.&#x0D; The information presented herein is sent to rehabilitation medicine specialists.

COMPARATIVE ANALYSIS OF THE INCIDENCE OF SPINAL DISTORTIONS IN ADOLESCENTS FOR THE PERIOD 2009-2021

Purpose: The study objective is to monitor changes in the incidence of spinal distortions in adolescents in the school years 2008/2009 and 2019/2020 in schools within the territory of the town of Kazanlak. The report presents an overview of the manner and organization of preventive screenings of adolescents and options for subsequent treatment. Materials and methods: The study was carried out by specialists in physical and rehabilitation medicine (PRM) in the school physicians’ offices with the consent of the directors, class teachers, parents and the regional education inspectorate. The preventive screenings were carried out completely free of charge for the pupils, and the treatment of newly discovered spinal distortions was carried out in outpatient conditions and was taken over by the National Health Insurance Fund. Results: The study outcomes showed no change in the incidence of spinal distortions of pupils in classes 1 to 4. However, among children from classes 5 to 10, there is a significant increase in the incidence rate over a period of 10 years. Conclusions: The introduction of modern technologies in pupils’ daily lives and their increasingly active lifestyles over the last 10 years has led to an increase in spinal diseases. PRM specialists are the physicians responsible for restoring preventive screenings for spinal distortions in schools. Our study with subsequent treatment and prevention of these conditions shows a successful approach to dealing with the increased number of scoliosis cases in the town of Kazanlak. Our team believes that this approach can be effectively implemented in each region by the PRM specialists and would have a strong social, economic and health effect in the long term for the population of the Republic of Bulgaria.

Transitioning care for adolescents with spina bifida in the US: challenges for management.

Open spina bifida (OSB) is a common neural tube defect. Medical and surgical care involves addressing the baseline orthopedic, urologic, and neurological dysfunction as well as the changes or declines that may occur as the patient ages. Given the complexity of this disease, coordinated, multidisciplinary care involving specialists in neurosurgery, orthopedics, urology, rehabilitation and physical medicine, pediatrics, and psychology is necessary to establish and optimize baseline function. Traditionally in the US, pediatric multispecialty spina bifida clinics have provided the patient with a coordinated medical support system. Unfortunately, this coordinated, medical home has been difficult to establish during the transition from pediatric to adult care. Medical professionals must have a strong understanding of OSB to properly manage the disease and detect and prevent associated complications. In this manuscript, we (1) describe the changing needs and challenges of people living with OSB over a lifespan, (2) delineate current practices in the transition of care for people with OSB from childhood to adulthood, and (3) provide recommendations for best practices in navigating the transition process for clinicians who provide care for those afflicted with this most complex congenital abnormality of the nervous system compatible with long term survival.

The Effects of Shock Wave Therapy on Spasticity and Walking Ability in People with Stroke: A Comparative Study of Different Application Sites

This study was conducted to investigate the effects of extracorporeal shock wave therapy on the improvement of walking ability through a reduction in spasticity in stroke patients. Thirty-three patients diagnosed with ischemic stroke by a rehabilitation medicine specialist were randomly assigned to three groups. The patients were divided into experimental group 1 in which shock waves were applied to the muscle-tendon junction, experimental group 2 in which shock waves were applied to the middle of the muscle, and experimental group 3 in which shock waves were applied to both the muscle-tendon junction and the middle of the muscle. The MAS was used to evaluate spasticity in the subjects, and the Dartfish software was used to measure knee and ankle angles during heel-off when walking. Based on the results of the study, a significant decrease in spasticity and increased joint angles were found in experimental groups 1 and 3 compared to experimental group 2, and the change in joint angle was significantly greater in experimental group 3 than in experimental groups 1 and 2. These results indicate that treatment effect may vary depending on the application site of the shock wave, and to obtain the best treatment effect, the shock wave should be applied to both the muscle-tendon junction and the middle part of the muscle.

Effects of Overlapping Action of Clinically Applied Rehabilitation Interventions Based on the Theory of Neuroplasticity

This study was invested to investigate the effects of a treatment method that can apply the theory of neurorehabilitation for rehabilitation treatment of stroke patients on spasticity, balance ability, and walking ability. In this study, 30 people diagnosed by a rehabilitation medicine specialist were divided into experimental group A and experimental group B through a random assignment method. Experimental group A received extracorporeal shock wave therapy on the paralyzed lower extremity after proprioceptive neuromuscular facilitation treatment, and experimental group B received non-gravity treadmill training after proprioceptive neuromuscular facilitation treatment. All treatments were performed 3 times a week for 6 weeks, and pre- and post-evaluation were conducted. Spasticity, gait speed, dynamic balance ability, and ankle angle were measured to evaluate the treatment effect. In the results of the study, the decrease in spasticity was statistically significantly higher in experimental group A than in experimental group B, and the improvement in walking speed and dynamic balance ability was statistically significantly higher in experimental group B than in experimental group A. In addition, the change in ankle angle was greater in experimental group A than in experimental group B. In conclusion, various treatment methods should be applied simultaneously to improve the quality of life and quickly return to society in stroke patients.

Toxine Botulique de type A et médecine du sport: ­revue de littérature et applications pratiques

In sports medicine, Botulinum Toxin type A (BoNT-A) can sometimes be used as an alternative for some of the most common pathologies of the musculoskeletal system. The objective of this narrative review is to identify the main current indications for BoNT-A in common sports pathologies, the technical conditions for its use, the doses used, and the main beneficial or adverse effects expected, in order to allow a practical approach for the clinician. The injections are performed by a Physical and Rehabilitation Medicine or Sports Medicine specialist, and requires an operator trained in EMG and/or ultrasound muscle detection. The main indications are epicondylalgia, plantar fasciitis, chronic exertional compartment syndrome (CECS), the functional popliteal artery entrapment syndrome (FPAES) and patellofemoral syndrome. The main effect sought being muscle-relaxant, undesirable transient paresis may occur, requiring some precautions regarding the dose used and a search for the optimal period in the sports calendar in order to minimize this risk. Despite the multiplication of recent studies on the subject, the current level of evidence remains low and limits the use of BoNT-A to cases of failure or contraindication to first- or second-line treatments, and is performed without any guarantee of financial coverage.

Functional level of lesion scale: Validating fourteen years of research with the national spina bifida patient registry.

Functional level of lesion (FLOL) is a grading of the level of neurological function in patients with myelomeningocele and other forms of spina bifida. It has been widely used as an independent variable in studies of spina bifida, but its inter-rater reliability has not previously been tested. The purpose of this study was to measure inter-rater reliability of FLOL testing and compare testing performed by a non-medically trained research associate to testing performed by a pediatric rehabilitation medicine specialist. Children in a multi-disciplinary spina bifida clinic underwent FLOL grading by a non-medically trained research associate. On the same day, these children were also graded by a pediatric rehabilitation medicine specialist. Cohen's weighted kappa statistic was used to compare grading, with the rehabilitation medicine specialist considered the gold standard. A total of 71 patients participated. FLOL was graded for left and right leg for each participant, resulting in 142 measurements. Cohen's weighted kappa was κ= 0.809, with a standard error of 0.034 and 95% confidence interval 0.723-0.875, indicating substantial agreement. FLOL as measured according to the instructions of the National Spina Bifida Patient Registry by a non-medically trained researcher is a reliable method to grade lower extremity function in spina bifida.

Functional Neurological Disorders in the medical education: An urgent need to fill the gaps

BackgroundFND is a disabling disease that accounts for 5 to 10% of the reason for consultation in neurology. However, young physicians often say they have little or no training in their management. AimThe aim of the present study was to assess whether French junior neurologists, psychiatrists and physical and rehabilitation medicine (PRM) specialists received teaching on FND during their medical studies, including the residency, and to evaluate their knowledge and perception of the disorder. MethodsThe survey was distributed by the means of a Google form questionnaire to specialist registrars and young specialists with the help of resident's organizations. Results568 respondents from the 3 specialties were included in the study. Most respondents (72.4%) were specialists registrars. Almost half of the respondents (45.5%) answered they never received any teaching on FND, and only 20.5% of them knew the Hoover's sign, a positive sign specific of functional weakness. A large majority of respondents felt they were not sufficiently trained in FND (87.9%), and they did not have sufficient knowledge of these disorders (85.3%). DiscussionBetter training would allow clinicians to make a diagnosis earlier, to better explain it to patients, and to limit the costs associated with diagnosis delays. A better training of clinicians about FND would also improve the prognosis of patients, as early diagnosis and good explanation is associated with a better prognosis. ConclusionThis survey shows that there is a gap about FND in the training programs in the medical studies and during the specialization training of young doctors in France.

Development of a Cranial Suture Traction Therapy Program for Facial Asymmetry Correction Using the New Delphi Technique.

Background and Objectives: We aimed to develop a cranial suture traction therapy program, a non-surgical therapeutic method for facial asymmetry correction. Materials and Methods: Six experts, including rehabilitation medicine specialists, oriental medical doctors, dentistry specialists, five experts, including Master’s or doctoral degree holders in skin care and cosmetology with more than 10 years of experience in the field, 4 experts including educators in the field of skin care, a total of 15 people participated in the validation of the development of the cranial suture traction therapy program in stages 1 to 3. Open questions were used in the primary survey. In the second survey, the results of the first survey were summarized and the degree of agreement regarding the questions in each category was presented. In the third survey, the degree of agreement for each item in the questionnaire was analyzed statistically. Results: Most of the questions attained a certain level of consensus by the experts (average of ≥ 4.0). The difference between the mean values was the highest for the third survey at 0.33 and was the lowest between the second and third surveys at 0.47. The results regarding the perceived degree of importance for each point of the evaluation in both the second and third stages of the cranial suture traction therapy program were verified using the content validity ratio. The ratio for the 13 evaluation points was within the range of 0.40−1.00; thus, the Delphi program for cranial suture traction therapy verified that the content was valid. Conclusions: As most questions attained a certain level of consensus by the experts, it can be concluded that these questions are suitable, relevant, and important. The commercialization of the cranial suture traction treatment program will contribute to the correction and prevention of facial dislocations or asymmetry, and the developed treatment will be referred to as cranial suture traction therapy (CSTT).

QOL-03. Beyond Survival: Clinical Rehabilitation and Functional Optimization Pearls for the Neuro-Oncologist

Over the past decades, major advances in treatment for pediatric brain tumors have led to higher survival rates. Management including surgical resection, chemotherapy and radiation have led to prolonged survival though each comes with potential deleterious impact upon a child's level of function. While function-sparing treatments continue to be developed and utilized each year, the standard of care for many conditions leaves our patients with the potential for worsening function. The areas of mobility, activities of daily living, cognition, communication and swallow are all potentially impacted. Rehabilitation medicine specialists focus on detecting impairments, addressing them with practical interventions and improving the function our shared patients. Unfortunately, there is a worldwide scarcity of rehabilitation medicine physicians and the role of improving function often falls into the hands of the neuro-oncologist. A number of practical clinical assessments and interventions utilized by rehabilitation medicine specialists can be translated to the toolbox of the neuro-oncoligst. The aim of this presentation is to provide the neuro-oncologist with further abilities to enhance function with interventions that typically require low time investment. Topics covered will include the following: 1. What is spasticity, when is it necessary to treat and how is it treated? 2. Leg braces -- who needs them, who doesn't and what are the goals? 3. What physical exam signs can be utilized to detect peripheral neuropathy early and inform further treatment decisions with agents such as Vincristine. 4. What aspects of a gait assessment are high yield in detecting concern for clinical progression? The goal of this talk is high yield and low time investment.. It is unfortunately not applicable for a poster presentation. A minimum amount of time would be 15 minutes. If less time is available for the this presentation, a photo/video-based, rapid-fire format (similar to Tik-Tok content) could be utilized.

Rehabilitation of hemispatial neglect in stroke.

Hemi-spatial neglect (HSN) is a debilitating post stroke cognitive deficit resulting in reduced attention to stimuli presented in the contra-lateral hemi-visual field. It adversely impacts patient's medical recovery, activities of daily living and quality of life. Early referral to Rehabilitation Medicine specialist for thorough evaluation, prompt recognition of functional impairments and formulation of a comprehensive rehabilitation plan unique to patient is important. It is part of the comprehensive and holistic management of stroke patients with HSN. We summarize the current management strategies used for post-stroke HSN rehabilitation with the options including non-invasive brain stimulation, visuomotor feedback training, robotic rehabilitation and trans-dermal nicotine patch.

50th Anniversary Department of Rehabilitation Medicine, UP-PGH

50th Anniversary Department of Rehabilitation Medicine, UP-PGH

Topical issues of rehabilitation of patients with osteoporotic vertebral fractures

The literature review analyzed 20 Russian and 69 foreign publications on the rehabilitation of elderly patients with osteoporotic vertebral fractures. The article deals in detail with the prevalence, medical and social significance of pathological osteoporotic fractures, including vertebral deformities. The data confirming the importance of osteoporosis for physical and rehabilitation medicine specialists are presented. Changes in the quality of life, functional and gate disorders associated with osteoporotic vertebral fractures are described. Based on the available literature data, the principles of rehabilitation of patients with osteoporotic vertebral compression fractures are formulated, including the effectiveness of various methods of physical therapy, mechanotherapy and apparatus physiotherapy. From the standpoint of evidence-based medicine, the role of orthotics in the complex rehabilitation of such patients is described. Based on the analysis of literature data, it was concluded that the problem of osteoporosis is relevant for physicians working in the field of rehabilitation medicine; osteoporotic vertebral fractures are characterized by a high prevalence over the age of 50 years and are associated with a decrease in the quality of life, motor and functional limitations, and an increased risk of death, and well-planned medical rehabilitation programs including physical exercises, physiotherapy and orthotics can significantly improve patient functionality.

Rehabilitation in the intensive care unit (RehabICU). Clinical practice recommendations of the national Union of Physical and Rehabilitation Medicine Specialists of Russia and of the national Federation of Anesthesiologists and Reanimatologists

After discharge from the Intensive Care Unit (ICU), more than 50 % of patients experience pathological symptoms that are not related to the primary emergency but reduce the quality of life and require rehabilitation. Post Intensive Care Syndrome (PIСS) include only those conditions that do not have a direct causal relationship with the emergency condition that gave rise to hospitalization in the ICU. The pathophysiological basis of the PICS is the phenomenon of “learned non-use”: a state of artificial limitation of the patient’s motor and cognitive activity as a result of the use of analgosedation, bed rest and immobilization. The clinical picture of PICS is determined by the severity of its individual components, detailed using a package of clinimetric scales. Based on the results of dynamic testing, the PICS severity index is calculated. The sum of the scores in the range from 0 to 10 reflects the severity and effectiveness of rehabilitation measures. For the prevention of PICS, the Union of Rehabilitologists of Russia together with the Federation of Anesthesiologists and Resuscitators of Russia has developed the rehabilitation complex “ReabICU”. In the English-language literature, such a complex is called “Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility” bundle. ReabICU is a complex of technologically therapeutic and diagnostic modules “positioning and mobilization”, “prevention of dysphagia and nutritional deficiency”, “prevention of emotional and cognitive impairment and delirium”, “prevention of loss of self-care skills”. The basis of the multidisciplinary rehabilitation team, which includes a doctor for medical rehabilitation, 2 specialists in physical rehabilitation, a specialist in occupation therapy, a medical psychologist, a medical speech therapist, a nurse for medical rehabilitation. The activity of multidisciplinary rehabilitation team is evaluated on the basis of quality criteria and the achievement of the main goal of ReabICU — the preservation of the premorbid status of the patient’s socialization.&#x0D; &#x0D;

The State of Pulmonary Rehabilitation in Latin America During the COVID-19 Pandemic

Background: In December 2019, China reported a severe upper respiratory failure syndrome caused by a new virus identified as coronavirus COVID-19. Aims and Objectives: The aim of this exploratory study is to outline the current state of pulmonary rehabilitation in Latin American (LA) countries during the COVID-19 pandemic. Materials and Methods: A total of 1162 rehabilitation professionals (rehabilitation medicine specialists and residents, physiotherapists, occupational therapists, and speech therapists) from 20 countries in LA answered a 34-question online survey related to the current state of pulmonary rehabilitation in LA during the COVID-19 pandemic. Results: More than half of the professionals reported the absence of pulmonary rehabilitation services in their work centers, limited or non-existent pulmonary rehabilitation materials or equipment, and little or no training by their multidisciplinary team and themselves. Regarding COVID-19, 49.2% of the respondents indicated not receiving the necessary material for the protection against COVID-19, and more than half reported limited equipment to perform interventions in patients hospitalized by this disease, and not to have clear about the recommendations to prescribe pulmonary physiotherapy in these patients. Moreover, almost all the professionals did not feel capable of treating patients with lung disease from COVID-19 and felt anxiety doing it. Conclusion: Pulmonary rehabilitation is vital for providing optimal care for respiratory impairments, and this relationship has been magnified by the COVID-19 pandemic. This manuscript highlights the limited professional training and resource availability in LA and provides recommendations to improve the current situation.

2019 Sidney Licht Lecture

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).