Management of spasticity

Spasticity is a major challenge to the rehabilitationteam. Spasticity can prevent or hamper function, causepain, disturb sleep, cause unnecessary complicationsand present major difficulties for care workers. Thisarticle reviews the variety of options available for theclinical management of spasticity. The need for cleartreatment goals and robust outcome measures isemphasized. The initial management should focus onthe alleviation of external exacerbating causes beforespecific treatment is considered. Physiotherapy is vitalfor correct positioning, seating, use of orthoses, splintsand casts and for other anti-spastic measures such asuse of heat and cold and electrical stimulation. The useof oral medication is discussed. Peripheral nerve blocksand botulinum toxin are two local treatments whichare proving very useful and are under-used and under-valued. In more severe cases intrathecal medication canbe helpful. Surgical procedures such as rhizotomy andorthopaedic corrections may sometimes be necessary,but usually only for the most severe cases or for thosewho have been poorly managed in the earlier stages.Overall, the clinical management of spasticity oftendepends on a variety of different approaches, necessitat-ing the involvement of a comprehensive rehabilitationteam.