Management of spasticity revisited
Spasticity is common after stroke and other neurological conditions and causes considerable limitations of movement, ADL and participation. Interaction with other components of the upper motor neurone syndrome (weakness, clonus and reduced postural responses) and the heterogeneity of patients' presentations together with limited tools for outcome measurement have hampered proper research for management strategies.
Spasticity is defined as ‘disordered sensorimotor control resulting from an upper motor neurone lesion, presenting as intermittent or sustained involuntary activation of muscles’.
Interactions between the ‘neural’ components of the spinal stretch reflex mechanisms which cause muscle tightness and fixed ‘non-neuronal’ stiffening and shortening of muscle fibres and supporting soft tissues, form the basis of resistance to movement.
Spasticity management currently consists of the following treatments:
- adequate 24-h positioning and consideration of trunk, head and limb posture, using a range of positioning tools
- daily active/passive movement programme for the maintenance of range of joint movement
- standing and weight bearing: stretching to combat contracture development
- thermoplastic splinting and serial plaster casting to maintain ROM
- pharmacological treatment: oral, local injection (botulinum toxin) and intrathecal
Specialist multi-disciplinary goal-centered management programmes are the mainstay of treatment. Targeted intramuscular botulinum toxin injection is now the most popular pharmacological treatment. Intrathecal therapies play a lesser role.
> From: Graham et al., Age Ageing 42 (2014) 435-441. All rights reserved to Oxford University Press. Click here for the Pubmed summary.
