Spasticity

Physical and Occupational Therapy

Physical therapy for spasticity refers to a range of physical (as opposed to drug or surgical) treatments. These treatments are designed to reduce muscle tone, maintain or improve range of motion and mobility, increase strength and coordination, and improve comfort. The choice of treatments is individualized to meet the needs of the person with spasticity. Treatments may include:

Stretching
Stretching forms the basis of spasticity treatment. Stretching helps to maintain the full range of motion of a joint, and helps prevent contracture, or permanent muscle shortening. To be effective, the prescribed stretching routine must be done regularly, usually once or twice a day.

Strengthening
Spasticity often leads to loss of strength in both the spastic muscles and surrounding ones. Strengthening exercises are aimed at restoring the proper level of strength to affected muscles, so that as tone is reduced through other treatments, the affected limb can be used to its fullest potential.

Orthoses and casts
Orthoses, or braces, allow a spastic limb to be maintained in a more normal position. For instance, an ankle-foot orthosis can help keep the foot flexed and reduce contracture of the calf muscles. A cast is a temporary brace. Serial casting gradually stretches out a contractured limb through the application of successive casts.

Positioning
Proper limb positioning improves comfort and reduce spasticity. Positioning includes seating in the wheelchair, bed position, and position of the upper limbs.

Cold
Application of cold packs to spastic muscles (usually for 10 minutes or longer) may improve muscle tone. While the effect doesn't last long, it may be used to improve function for a short period of time, or to ease pain.

Electrical stimulation
Electrical stimulation may be used to stimulate a weak muscle to oppose the activity of a stronger, spastic one. It may also reduce spasticity for short periods of time. Electrical stimulation is most often used to help flex the ankle for walking, and to help extend spastic fingers.

Biofeedback
Biofeedback is the use of an electrical monitor that creates a signal—usually a sound—as a spastic muscle relaxes. In this way, the person with spasticity may be able to train himself to reduce muscle tone consciously. There has been little research testing the effectiveness of biofeedback for reducing spasticity.