Spasticity

Treatment

Left untreated, spasticity can lead to contracture. However, not all spasticity requires treatment. Indeed, in some cases, the inappropriate treatment of spasticity may lead to loss of function, particularly when spasticity is counterbalancing the effects of paresis. Before beginning therapy, it is important for the clinician to differentiate rigidity and contracture from spasticity. Rigidity causes an overall involuntary increase in resistance of a muscle to passive stretch. In rigidity, this increased tone is uniform throughout the range of motion of the muscle being stretched and, unlike in spasticity, is not velocity dependent. In addition, spasticity causes an increase in deep tendon reflexes, whereas rigidity does not. Contracture is a fixed shortening of the muscle, tendons, or ligaments—or a combination thereof—that prevents normal movement of the associated joint or limb. Untreated contracture can result in permanent deformity.

Another important consideration before commencing treatment is to determine which muscles are involved in spasticity. Standardized techniques to ascertain range of motion may yield valuable information regarding the effects of spasticity. However, motor point or nerve blocks may be necessary to clearly delineate the role of agonist and antagonist muscles.

Spasticity may need to be treated when it causes

• Pain
• Difficulty performing activities of daily living
• Impaired mobility, whether related to ambulation or transfers
• Poor joint positioning
• An increased risk for the development of contracture
• Skin breakdown