Integrating Spasticity Management: Practical Approaches for All PM&R Practices (Member Resource)-Session Recording

Video Transcription

Video Summary

Dr. Tina Kwasnika leads a panel discussion with Drs. Zach Bohart, Atul Patel, and Joe Burris on integrating spasticity management into physical medicine and rehabilitation (PM&R) practice across inpatient and outpatient settings. They emphasize the high prevalence of spasticity in stroke, brain injury, cerebral palsy, and MS patients, and discuss barriers to care such as geographic access, inconsistent follow-up post-inpatient rehab, and difficulties treating nursing home and LTAC residents. <br /><br />The physicians describe different referral pathways and strategies to build a spasticity practice: establishing multi-location clinics to improve patient access, creating a reputation as a spasticity specialist, collaborating closely with therapists, orthotists, neurosurgeons, and primary care providers, and actively communicating treatment successes to grow referrals. Some note the challenge of inconsistent referral patterns, with many patients not seeing rehab physicians early or regularly.<br /><br />They highlight treatment considerations, including holistic patient care beyond injections (botulinum toxin, phenol, intrathecal baclofen), individualized therapy coordination, and preventing complications in acute and chronic phases. Approaches vary by setting, with challenges in providing certain treatments in LTACs or nursing homes due to insurance and institutional policies.<br /><br />Financial and operational issues are a focus: spasticity treatment carries low reimbursement, significant administrative burden, and requires efficient practice management, prior authorizations, and diligent billing oversight to sustain viability. The role of advanced practice providers is discussed as a way to increase capacity, though quality control and appropriate training are essential.<br /><br />The panel encourages new physicians entering spasticity care to seek mentorship, start gradually, build collaborative networks, focus on quality patient care alongside financial realities, and embrace the rewarding nature of this specialized rehabilitation field.

Keywords

spasticity management

physical medicine and rehabilitation

stroke

brain injury

cerebral palsy

multiple sclerosis

referral pathways

multi-location clinics

interdisciplinary collaboration

botulinum toxin

intrathecal baclofen

advanced practice providers