Management of Spasticity Revisited

Laura A. Graham


Age Ageing. 2013;42(4):435-441. 

In This Article

Abstract and Introduction


Spasticity is common after stroke and other neurological conditions and causes considerable limitations of movement, activities of daily living and participation. Interaction with other components of the upper motor neurone syndrome (UMNS) and the heterogeneity of patients' presentations together with limited tools for outcome measurement have hampered the production of randomised controlled trial data for management strategies. Specialist multi-disciplinary goal-centered management programmes are the mainstay of treatment. Pharmacological therapies have limited effect, and physical and positional management are crucial. Targeted intramuscular botulinum toxin injection is now the most popular pharmacological treatment. Intrathecal therapies also play a lesser role. A team approach and holistic assessment are essential to beneficial outcomes.


Spasticity is a neurological condition affecting movement which can cause muscle stiffness, pain, loss of joint range and loss of function. Difficulties for patients include problems maintaining personal hygiene and independent dressing. Comfortable seating and maintenance of adequate posture are difficult. Reduced arm function affects activities of daily living and lower limb spasticity causes compromised gait patterns, with loss of mobility and an increased risk of falls. There may be decreased mood and social interactions, resulting in an increased carer burden and a risk to family relationships.

For this review, relevant papers were identified using medline and embase. Despite the impact of the condition, the literature is limited with regard to the evidence for optimal management.