Spasticity

Outlining the Treatment Goals

The primary aim of treatment is to improve quality of life for people with spasticity and for their caregivers. Therefore, the development of treatment goals should always include these key individuals, with realistic expectations clearly defined in collaboration with other members of the spasticity management team. The patient's ability to fully engage in and to have the resources necessary to participate in the rehabilitation program must be ensured prior to commencing therapy. Throughout the course of treatment, alterations in the treatment plan should be based on response to therapy, with expectations redefined at regular, agreed-upon intervals.

Once the decision has been made that the spasticity should be treated and the patient, caregiver, and healthcare professionals are in agreement about the treatment goals, the question becomes which treatment to use. The patient's age, preferences, and ability to comply with treatment need to be taken into consideration. Other factors that determine the choice of treatment include the distribution (i.e., focal or diffuse), duration, and severity of the spasticity.28

The treatment of spasticity is usually initiated with the most conservative treatments that have the fewest risks. Therapy directed at reducing or eliminating spasticity almost universally involves a multimodal approach.28

A variety of factors may lead to or increase the severity of spasticity. These issues should be ruled out as underlying causes or exacerbating factors and should be effectively treated, if necessary, before attempting to treat the spasticity. Examples of commonly occurring causes of a new onset of spasticity or a worsening of existing spasticity include

• Urinary tract infections or retention
• Other sources of infection
• Pressure sores
• Extremes of heat or cold
• Fatigue
• Renal calculi
• Ill-fitting orthotics
• Constipation or bowel obstruction