What is Spasticity? 

Spasticity is a disorder of muscle tone resulting from damage to the central nervous system (brain or spinal cord). This condition causes muscles to remain constantly contracted and unable to relax, leading to restricted movements and discomfort. Spasticity is often a symptom of conditions such as cerebral palsy, multiple sclerosis, traumatic brain injuries, spinal cord injuries, and stroke.

Symptoms of Spasticity

• Muscle stiffness and spasms
• Uncontrolled muscle contractions
• Limited range of motion
• Pain and discomfort

Treatment and Management of Spasticity 

Managing spasticity starts with the proper selection of patients. It is crucial to evaluate the patient globally and be familiar with all treatment modalities. When determining the treatment algorithm, the following questions should be addressed:

• Whom should we treat?
• Why should we treat this patient?
• How should we treat this patient?
• When should we start treatment?
• What is the achievable outcome of the treatment?

Management of Spasticity in Children 

In managing spasticity and selecting patients, the developmental status of children is important. The fact that some of these children may have mental retardation should be considered, and treatment should be planned accordingly. The child’s cognitive ability significantly impacts the progression of treatment. Additionally, social and emotional development is an important factor during the treatment process.

Goals in Spasticity Management

• Reduce muscle tone
• Increase joint range of motion
• Make orthosis use appropriate
• Prevent contracture development
• Reduce the need for orthopedic interventions
• Decrease pain and spasms
• Improve cosmetic appearance
• Facilitate the application of rehabilitative approaches
• Enhance functions

Methods of Spasticity Treatment

1. Physical Therapy and Rehabilitation

   • Stretching Exercises: Regular stretching exercises are performed to increase muscle flexibility and reduce contractions.
   • Functional Training: Functional movement training is provided to facilitate daily activities.

2. Medical Treatment

   • Muscle Relaxants: Drugs like baclofen, tizanidine, and diazepam are used to reduce muscle tone.
   • Botulinum Toxin (Botox) Injections: Injections into spastic muscles temporarily reduce muscle contractions.
   • Intrathecal Baclofen: A pump system that delivers baclofen directly to the spinal cord is used for patients unresponsive to oral medication.

3. Surgical Treatment

   • Selective Dorsal Rhizotomy (SDR): Aims to reduce muscle tone by cutting certain nerve roots in the spinal cord, especially used in children with cerebral palsy-induced spasticity.
   • Orthopedic Surgery: Performed to correct contractures (shortening of muscles and tendons) and deformities.

4. Physical Aids

   • Splints and Orthoses: Used to support muscles and maintain correct positions.
   • Walkers and Wheelchairs: Assistive devices to enhance mobility and support independence.

5. Alternative and Supportive Therapies

   • Occupational Therapy: Provides patients with specific strategies and tools to increase independence in daily activities.
   • Speech and Language Therapy: Applied in cases where spasticity affects speech and swallowing muscles.

Multidisciplinary Approach in Spasticity Treatment 

A multidisciplinary approach is often adopted in the treatment of spasticity. This requires the collaboration of various specialties (physical therapy, neurology, orthopedics, neurosurgery, occupational therapy, etc.). Each patient’s condition should be evaluated individually, and a personalized treatment plan should be prepared. Early treatment and well-rehabilitated cases yield satisfactory results.

Conclusion

Treating spasticity requires a multidisciplinary team. Initially, the patient’s clinical, radiological, and movement capabilities are assessed. Subsequently, treatment methods are identified and implemented based on achievable goals for that specific patient. Early treatment and well-rehabilitated cases yield satisfactory results.