What is spasticity?
Spasticity is abnormal muscle stiffness that occurs as a result of spinal cord injury, brain injury, stroke, multiple sclerosis and cerebral palsy. If mild, spasticity may have no impact at all on daily functioning. More significant spasticity can be painful and can interfere with everyday activities like bathing, dressing, eating and mobility. Activities can become time-consuming and difficult for the individual, as well as the care givers. In the most severe form, joints and limbs can be completely “frozen,” leading to severe immobility, pain, pressure sores and dependence.
Recent developments, including botulinum toxin and intrathecal baclofen therapy, have led to more effective treatment and management of spasticity. A comprehensive assessment by a team of physicians and therapists determines if spasticity is contributing to problems with mobility and self care, what muscles are involved, and what treatment options are appropriate. The Spasticity Management Program has the expertise and a professional, caring team to treat patients.
What are available treatments?
- Conservative Management
Physical and occupational therapists provide strengthening, neuromuscular re-education, gait training, splinting and strategies to improve activities of daily living.
- Oral Medications
Medications, including baclofen, diazepam and tizanadine, may be prescribed alone or in conjunction with other treatments. The most common side effect is sedation.
- Botulinum Toxin Therapy
Botulinum toxin is an inhibitor of spasticity and is best used when limited numbers of muscles on one or two limbs are affected. The toxin is injected using a small needle; the effect usually lasts 3 to 4 months. Discomfort is minimal, and significant side effects are rare.
- Nerve Blocks
Lidocaine or Sensorcaine: These medications temporarily numb a nerve and can be helpful in evaluating which muscles are spastic and predicting the outcome of other treatments.
Phenol or Alcohol: These medications can inactivate a nerve for 9 months to 12 months and are more commonly used when spasticity affects large muscle groups. Side effects are minimal but may include numbness and tingling.
- ITB - Intrathecal Baclofen
Intrathecal Baclofen Therapy is an effective method for controlling significant, generalized spasticity. This therapy consists of surgically placing in the abdominal wall a small pump that delivers medication directly to the spinal fluid via a catheter. Side effects may include infection, excessive muscle looseness, nausea, headache and dizziness.
- Orthopedic Surgery
Some patients may be candidates for orthopedic surgery to correct deformities resulting from spasticity or to augment the effects of other anti-spasticity treatments.
Evaluation and Outcomes
At Advocate Christ Medical Center, our team consists of a:
- physiatrist neurosurgeon
- physical therapist
- occupational therapist
- rehabilitation advanced practice nurse
The key to successful treatment is clear identification of goals for spasticity management. Both patient and family are critical members of the team and will be included in the evaluation process. Their observations and expectations will be considered and incorporated into the final treatment plan.
The goals of spasticity treatment may include improvement in:
- functional mobility (such as transfers and walking)
- self-care skills
- skin care
- activities of daily living
- ease of caregiver burden
- pain relief