Spasticity Management
Spasticity is a complex phenomenon that the healthcare world is still learning about. At present there is no internationally agreed definition. At the most basic level, spasticity occurs when damage to the brain or spinal cord causes the messages to and from our central nervous system to become interrupted. This leads to involuntary over active muscle activity.
Treatment Options
NICE Guidelines, The BNF and RCP guidelines all outline evidence based treatment options. At Neuro Rehab PT we formulate bespoke management plans ensuring that our individual client's needs are managed with the most up to date evidenced based treatments.
Having qualifications in non medical prescribing, we work with your medical practitioners to develop a bespoke clinical management plan. Where possible, and if clinically achievable, we aim to minimise the prescription of systemic medications in order to reduce side effects such as fatigue and cognitive impairment, ensuring that participation in rehabilitation is maximised.
Why Worry?
When not effectively managed, spasticity leads to abnormal limb posture resulting in soft tissue shortening, and permanent biomechanical changes in the contracted muscles. This can lead to stiff and tight muscles that are more reflexic, and joints that become fixed in non functional positions.
Treatment goals
Common goals when treating spasticity are: pain relief, reduction of involuntary movements (e.g. associated reactions, spasms), prevention of contractures and deformity, passive function (making it easier to care for the affected limb), active function (using the affected limb) and improving mobility.
Spasticity Management in children
A systematic review of interventions for children with cerebral palsy: state of the evidence
Novak, I., Mcintyre, S., Morgan, C., Campbell, L., Dark, L., Morton, N., Stumbles, E., Wilson, S.-A. and Goldsmith, S. (2013), A systematic review of interventions for children with cerebral palsy: state of the evidence. Dev Med Child Neurol, 55: 885- 910
The evidence is clear on which interventions should and should not be used to treat spasticity in children; Botulinum toxin is the most effective treatment.
Spasticity Management in Adults
Local intramuscular injection of botulinum toxin is an established, well-tolerated treatment in the pharmacological management of focal spasticity. There is a strong body of Level 1 evidence for its effectiveness in the management of both upper and lower limb spasticity.
Botulinum Toxin injections can play a fundamental role in restoring function and maintaining physical conditioning.
Accuracy
Botulinum toxin will only be effective if the correct dosage is placed in the correct muscle. At Neuro Rehab PT we pride ourselves on achieving Best Practice, and utilise ultrasound to ensure accuracy of injection delivery.
Useful links
Paediatrics
NICE Guidelines 2016. Spasticity in under 19s: Management
https://www.nice.org.uk/guidance/cg145
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Adults
RCP Guidelines Spasticity in Adults: Management using botulinum toxin. National Guidelines 2018
https://www.rcplondon.ac.uk/guidelines-policy/spasticity-adults-management-using-botulinum-toxin
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NICE Guidelines 2019. Cerebral Palsy in Adults. Manging abnormal muscle tone
https://www.nice.org.uk/guidance/ng119/chapter/Recommendations#managing-abnormal-muscle-tone
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Pharmacological Management
