Five Questions With: Dr. Zachary Bohart

University Orthopedics recently launched its Comprehensive Spasticity Management Clinic, offering a new approach to spasticity treatment that is unique to Rhode Island and the Greater Boston area.

The clinic is led by Dr. Zachary Bohart, a board-certified psychiatrist and expert in spasticity management. Bohart spoke with Providence Business News about spasticity and treatments for the condition.

PBN: For those who don’t know, what is spasticity and how many people have it?

BOHART: Spasticity is involuntary muscle tightness and rigidity, which is a result of any injury to the brain or spinal cord. The five most common diagnoses are stroke, multiple sclerosis, cerebral palsy, spinal cord injury and traumatic brain injury. It is extremely common in these diagnoses.

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PBN: How does spasticity affect a patient’s daily life?

BOHART: Spasticity can impair active use of a muscle or joint, such as using one’s hand or walking or getting dressed. It may also impair caregiving and hygiene, such as cleaning one’s palm, performing groin hygiene, sitting comfortably in a wheelchair or sleeping at night. It can also impair progression with physical or occupational therapy after having a stroke during the most important time to recover neurologically.

PBN: Why has there been a shortage of doctors treating spasticity in Rhode Island and southeastern New England?

BOHART: There is a shortage of physicians performing this type of care because it is complex and usually takes a team, and many people in the field, physical medicine and rehabilitation, are more going into sports medicine or spine medicine, which does not treat these conditions. Most neurologists don’t treat this kind of condition because by the time patients develop spasticity after a stroke, they frequently are not seeing their neurologist anymore because spasticity can develop months after a stroke.

In addition, there is also no acute care rehabilitation hospital in Rhode Island, unlike Spaulding in Massachusetts. There is one opening up in Johnston shortly, Encompass Rehab, which will really be a major benefit to those suffering with neurologic disorders in the state of Rhode Island. I look forward to working with them. They are a national leader in taking care of this patient population.

PBN: Why is it particularly important that patients with spasticity receive timely treatment?

BOHART: It is important for patients to receive timely treatment for spasticity because spasticity can really impair someone’s level of functioning, and if not treated early enough, it can irretrievably decrease their level of functioning and force them to live in a nursing home, leave their job, etc.

In addition, if spasticity is not treated early, a joint can become contracted – locked in position – and at this point treatments for spasticity no longer work or don’t work as well. They will need surgery instead, and many of these patients are not surgical candidates or don’t want surgery.

PBN: Under what circumstances is injection treatment not appropriate for a spasticity patient, and what options are available?

BOHART: If a patient is using their spasticity to function or stand, we tend to either not treat or treat with very low doses because by treating their spasticity, it might decrease their level of functioning. However, this is why it’s important to see a physician who specializes in this, to determine specifically what the patient needs.

Katie Castellani is a PBN staff writer. You may contact her at Castellani@PBN.com