Clinical management of spasticity

• Published in: Journal of neurology, neurosurgery and psychiatry neurosurgery and psychiatry, 2005-04, Vol.76 (4), p.459-463
• Main Authors: Thompson, A J, Jarrett, L, Lockley, L, Marsden, J, Stevenson, V L
• Format: Article
• Language: English
• Subjects: Algorithms; Botulinum Toxins, Type A - therapeutic use; Cerebral palsy; Cerebral Palsy - complications; Cerebral Palsy - pathology; Cerebral Palsy - therapy; Electric Stimulation Therapy - methods; Fecal Incontinence - etiology; Fecal Incontinence - physiopathology; FES; functional electrical stimulation; Humans; management; Motor Neurons - pathology; Movement Disorders - diagnosis; Movement Disorders - etiology; Movement Disorders - therapy; Multiple sclerosis; Neural Inhibition - physiology; Neuromuscular Agents - therapeutic use; Pain; Patient Care Team; Physical Therapy Modalities; Severity of Illness Index; spasticity; Spinal cord; treatment; UMN; upper motor neurone; Urinary Bladder Diseases - etiology; Urinary Bladder Diseases - physiopathology
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp.2004.035972

A further problem-particularly in children with spasticity, which is often secondary to cerebral palsy-is the failure of normal muscle growth, resulting in torsion of long bones and consequent joint instability and degeneration. 16 Early identification and intervention to treat spasticity and associated symptoms such as spasms can minimise the development of these long term secondary complications.\n The effect of a single injection often lasts many months and can be repeated if necessary. 25 MONITORING SPASTICITY It is clearly helpful to adopt a management approach that is linked to the severity of the spasticity. Other clinical scales have been used, including clinician visual analogue scales or self report scales for spasm severity and frequency, though none has been shown to be reliable. 28, 29 There is thus still a need for development of a valid, responsive, and reliable scale to assess both the severity and the functional impact of spasticity and its associated features. 30 In addition to clinical scales, more complex techniques including pendulum tests or gait analysis can be employed, as well as simple goniometers allowing ranges of movement in relevant joints to be recorded and monitored. 31 In our experience several measures are necessary to complete a thorough evaluation of the severity and impact of an individual's spasticity.