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Spasticity is a common symptom of several neurological conditions, affecting over 12 million people worldwide. It causes muscles to contract all at once, leading to painful spasms and involuntary contractions. While there is no cure for spasticity, various treatment options are available to alleviate symptoms and improve quality of life. Treatment options include physical therapy, oral medication, injections, and in severe cases, surgery. The most effective approach often involves a combination of treatments and a team of healthcare professionals.
| Characteristics | Values |
|---|---|
| Treatment | Physical therapy, oral medication, injections, surgery |
| Physical therapy | Lower extremity stretching, strengthening exercises, mobility training, casting or bracing |
| Oral medication | Baclofen, diazepam, dantrolene sodium, tizanidine, clonidine |
| Injections | Botulinum toxin (Botox), phenol, local anaesthetic |
| Surgery | Selective dorsal rhizotomy (SDR), orthopaedic surgery, intrathecal baclofen (ITB) pump |
| Multidisciplinary team | Neurologist, physiatrist, advanced practice clinician, physical therapist, occupational therapist, speech and language pathologist, neurosurgeon, orthopedic surgeon |
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Physical therapy
A physical therapist will typically focus on lower extremity stretching and strengthening exercises and mobility training (transfers, standing, and walking). The choice of treatments is individualized to meet the needs of the person with spasticity. Physical therapy can also include temporary casts or braces, therapeutic heat, cold, electrical stimulation, and biofeedback.
Cryotherapy, using cold packs (12°C) for 20 minutes, can lower the muscle temperature to reduce spasticity. Electric stimulation using agonist stimulation has been shown to improve Ashworth scores, while antagonist stimulation showed an increase in the stretch reflex-initiating angle.
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Oral medication
Baclofen is often considered the first-line treatment for muscle spasticity, especially in adult spinal cord injuries (SCI). It works by restricting the influx of calcium into the neural receptors and increasing the influx of potassium, leading to a decrease in the number of messages nerve cells transmit. Oral baclofen may not be suitable for elderly patients due to excessive drowsiness.
Dantrolene sodium is unique among the medications as it affects muscle fibre rather than nerve fibre. It reduces the release of calcium that usually occurs after muscle action. Dantrolene is the only oral antispasticity medication approved by the US Food and Drug Administration, but caution is advised due to reports of liver failure and, in rare cases, fatalities at high doses.
Diazepam is a central nervous system depressant, while tizanidine is a centrally acting muscle relaxant that is used in patients with predominantly upper motor neuron involvement.
Other oral medications that may be useful in reducing muscle spasticity include pharmaceutical cannabinoids, plant-based cannabinoids, and fish oil. However, research on the medicinal properties of cannabis is limited, and it is not a widely recommended treatment option. Over-the-counter medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen can also be used to treat the pain and inflammation associated with muscle spasticity.
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Botox injections
It is important to note that Botox may cause serious side effects that can be life-threatening. Get medical help right away if you experience problems swallowing, speaking, or breathing due to the weakening of associated muscles. Serious and/or immediate allergic reactions have also been reported, including itching, rashes, dizziness, or asthma symptoms.
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Surgery
One surgical procedure used to treat spasticity is selective dorsal rhizotomy (SDR), a technique that involves cutting carefully selected nerve roots to rebalance the electrical signals sent to the spinal cord. This procedure is performed under general anaesthesia and targets nerve roots between the L2 and S1 or S2 levels, just outside the vertebral column. SDR is typically recommended for individuals with severe spasticity in the legs, particularly those with cerebral palsy.
Intrathecal baclofen (ITB) therapy is another surgical treatment option. This involves placing a pump in the abdomen that delivers a steady dose of medication directly to the spinal fluid through a catheter. ITB therapy has been found to significantly reduce spasticity and pain while lowering the risk of drowsiness compared to oral medication. It is considered safe and effective, especially for children with severe spasticity due to cerebral palsy.
Orthopaedic surgery is also an option for treating the consequences of spasticity on muscles, bones, and connective tissue. This type of surgery can address issues such as decreased muscle flexibility, diminished joint mobility, and deformities that may result from untreated spasticity.
While surgery can be beneficial, it is important to note that non-invasive, non-surgical approaches are typically the first line of treatment for spasticity. Physical therapy, medication, and botulinum toxin injections are often used before considering surgery. Additionally, a multidisciplinary team approach, including professionals such as neurologists, physiatrists, physical therapists, and orthopaedic surgeons, is recommended for the most effective management of spasticity.
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Occupational therapy
Spasticity is a condition that causes muscle stiffness and pain. It is characterised by involuntary muscle contractions, which occur due to a breakdown in communication between the brain and muscles following a neurological injury. This results in a velocity-dependent increase in muscle tone to passive movement, creating an inability to stretch muscles or coordinate movements effectively.
Additionally, casting or bracing can be used to provide sustained stretches to spastic muscles, improving their range of motion and facilitating better function. This can be done in conjunction with occupational therapy to enhance its effects.
Overall, occupational therapy plays a vital role in the treatment of spasticity by addressing the underlying neurological issues and promoting independence in daily activities.
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Frequently asked questions
Spasticity is a disruption in muscle movement patterns that cause certain muscles to contract all at once, making daily tasks painful. It can be caused by an imbalance in electrical signals to certain muscles.
Symptoms include continuous muscle stiffness, spasms and involuntary contractions, which can be painful. It may result in growth problems, painful and
Treatment options include physical therapy, oral medication, injections, surgery, and complementary and alternative medicine.
Botulinum toxin (Botox) injections and phenol injections are used to treat muscle spasticity.
Selective dorsal rhizotomy (SDR) and intrathecal baclofen (ITB) pump placement surgery are used to treat muscle spasticity.
