Spasticity

Physical and Occupational Therapy

Physical therapy, occupational therapy, or both are included in most patients' treatment regimens, with the level of the patient's and caregivers' motivation strongly associated with outcome. These therapies are targeted at reducing muscle tone; improving range of motion, mobility, comfort, and strength; and enhancing independence and the performance of activities of daily living.29,30

Orthoses include any device that is used to support, align, prevent, or correct deformities or to improve the function of movable parts of the body.31,32 The primary goals in treating spasticity with orthoses include

• Preventing deformities and the breakdown of skin
• Inhibiting tone
• Maintaining the length of muscle fibers
• Elongating shortened tissues, thereby prolonging proper positioning
• Optimizing position
• Increasing or maintaining range of motion
• Decreasing pain

Serial inhibitory casting involves the gradual stretching of a limb to provide "stress relaxation" to the muscle, thereby increasing the range of motion and preventing contracture or relieving a previously developed contracture. A temporary hard cast is placed on the affected limb at five degrees less than the maximum range that triggers spasticity. The cast is removed every three to five days, the limb is stretched slightly further, and another cast is applied, with the process continuing until maximum positioning of the joint is achieved. At that time, a bivalve cast is applied. Constant watchfulness is required to prevent skin breakdown and the formation of pressure sores.32-34