What should be considered prior to spasticity treatment selection?

Updated: Mar 01, 2018
  • Author: Krupa Pandey, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

A variety of strategies are available for the management of spasticity. The treatment of children with spasticity has been the subject of innumerable publications, most of them surprisingly uncritical and devoid of controls. A vital preliminary consideration is the indication and expectations for treatment. In a patient who can walk, for example, a reduction of leg muscle tone may worsen mobility if tone compensates for leg weakness, allowing the patient to stand. Manual dexterity and strength also do not improve by reducing muscle tone, which means that treatment of spasticity may not lead to an improvement in function.

Therefore, clearly identifying the goals of the patient and caregiver is vital and before treatment is initiated, the following should be considered [16] :

  • Does the patient need treatment?

  • What are the aims of treatment?

  • Do the patient and caregivers have the time required for treatment?

  • Will treatment disrupt the life of the patient and caregivers?

Specific functional objectives in the management of spasticity include strategies aimed at improving gait, hygiene, activities of daily living (ADLs), pain, and ease of care; decreasing the frequency of spasm and related discomfort; and eliminating noxious stimuli.

The ability of muscles to function after spasticity reduction varies. Treating spasticity does not always facilitate the acquisition of previously undeveloped skills.

Agonist versus antagonist muscle groups

When deciding to treat a spastic muscle, it is important to assess the impact of its antagonistic muscle groups. While often weak, these muscle groups themselves may be spastic. Treatment of the agonist muscle without treatment of the antagonist muscle may create an additional problem instead of a solution. Additionally, careful assessment of the role spasticity plays in substituting for strength (specifically, to facilitate with transfers) is important to avoid decreasing, rather than increasing, function.


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