Treatment and prevention of contractures usually combines medication to relieve spasticity with physical and occupational therapy. Occupational therapy for spastic cerebral palsy occupational therapy is a type of therapy that utilizes common tasks in daily life 5. In the past decade, traditional rehabilitation for spasticity, such as occupational therapy and physical therapy, has been augmented by pharmacotherapy such as botulinum toxin a bonta, which has been shown to reduce spasticity. Physical therapy for cerebral palsy improving mobility. Due to its negative impact on emotional and physical function, spasticity can result in lower. The goals of physical and occupational therapy are stretching. Spasticity management and treatment cleveland clinic. These methods include drug therapy, chemical and surgical denervation, physical therapy, and sometimes surgical alteration of tendons. They help patients maximize movement, plan adaptations and coordinate care with the rest of the treatment team. Then, generally, a combination of exercises, muscle relaxing techniques and special equipment is used to improve movement. To help you overcome spasticity and get stiff muscles to relax, well share the best exercises to help get the brain on board. Physical therapists, occupational therapists and speech therapists offer valuable expertise to patients of the comprehensive spasticity management program. Judy gooch, a rehabilitation doctor talks about treating spasticity after a stroke.
Spasticity is a component of the upper motor neuron syndrome umns. Lessening the spasticity in a patients muscles can allow them to participate in physical therapy and complete exercises that will help them recover. Discuss treatment goals for patients with spasticity, including prevention of complications. Department of physical medicine and rehabilitation, stroke rehabilitation and comprehensive spasticity management, medical college. Spasticity is defined as velocity dependent resistance to movement. When treating a patient who shows spasticity it is necessary to carry out three important aims. Spasticity treatment exercises dont just target your muscles they help rewire your brain. Botulinum toxin is the most widely used treatment for focal spasticity. Physical therapy is the science of treating people with physical special needs or those who may develop physical disabilities, to help them minimize andor maintain basic functional abilities e.
Role of physical therapist for management of spasticity. Clinical management of spasticity journal of neurology. Pdf physiotherapy management of spasticity researchgate. Sections of this booklet detail what can be accomplished by physical therapy, medication, orthotic devices splints or braces and occupational therapy. Evaluation of electrical stimulation as a treatment for.
In summary, stretching activities have the advantage of being a local treatment, with limited risk that has demonstrated proven effect in the management of spasticity. Neurodevelopmental physical therapy improves spasticity, but. Given the lack of well controlled studies, it is difficult to take an evidencebased approach regarding the use of these interventions at this time. Spasticity is a motor disorder marked by a velocitydependent increase in muscle tone or tonic. Unusual tightness in your childs muscles, sometimes caused by spasticity, can interfere with his or her ability to eat, talk and move. Mdfrom the department of physical medicine and rehabilitation, university of texas health science centerhouston, tx g. Physical treatment interventions for managing spasticity after stroke. Spasticity occurs when a muscle involuntarily contracts when you move. Various systems of exercisesare employed in the symptomatic pdf nyc subway map treatment of spasticity. Physical and pharmacological treatments can reduce pain and discomfort without compromising function. Spasticitymuscle tightness and tone management program. The effect of the toxin is to inhibit the release of. Physical and occupational therapy for spasticity can include specific stretches and exercises designed to relax your muscles to keep your tendons from shortening.
Pharmacological treatment of spasticity drug treatment can be used for generalised spasticity or targeted to focal problems, and can include agents such as botulinum toxin or intrathecal baclofen and phenol. How physical therapy is treating my spasticity and pain. Spasticity is a motor disorder marked by a velocitydependent increase in muscle tone or tonic stretch reflexes associated with hypertonia. Treatment of spasticity by exposure to cold physical. They also provide a variety of treatments, including. Evaluation of electrical stimulation as a treatment for the. Spasticity is a common symptom seen in many neurological conditions, notably head injury, spinal cord injury, stroke, cerebral palsy, and multiple sclerosis. Stroke multiple sclerosis brain injury spinal cord injury cerebral palsy can be used with or in place of orally administered antispastic medications nondestructive, adjustable, and reversible therapy by. Surgical treatment for spasticity is an option in patients with significant quality of life. Andrea toomer and culicchia neurological clinic, undergoes physical therapy as she continues treatment for spasticity.
The upper motor neuron syndrome is caused by a lesion proximal to the anterior horn cell. Spasticity is a condition in which there is an abnormal increase in muscle tone or stiffness of muscle, which might interfere with movement, speech, or be associated with discomfort or pain. Managing severe spasticity rady childrens hospital. Nov 01, 2014 in the past decade, traditional rehabilitation for spasticity, such as occupational therapy and physical therapy, has been augmented by pharmacotherapy such as botulinum toxin a bonta, which has been shown to reduce spasticity. Rehabilitation therapies after botulinum toxina injection to. Baclofen pump therapy for the treatment of spasticity. Physical therapy in spasticity richardson 2002 european. It can be painful like a charley horse and can create stiffness and tightness. Physical therapy is crucial when a child has had surgery to help correct spasticity. Spasticity in adults british society of rehabilitation medicine.
Jul 05, 2017 the study, published in the journal of physical therapy science, was titled effect of neurodevelopmental treatmentbased physical therapy on the change of muscle strength, spasticity, and gross motor function in children with spastic cerebral palsy. Appropriate for all spasticity treatment options 5 is the spasticty generalized or focarelated to the clinical problem. By injecting botox into the affected muscles, the risk of spasms and spasticity is reduced. Neuro developmental treatment ndt techniques history. Speech therapy can also be done by patients whose spasticity has affected their speech. To identify any adverse effects of physical treatment interventions for spasticity. Treatments to achieve optimal muscle tone include physical therapy and rehabilitation program. Spasticity treatment program should be established after detailed evaluation of degree and effects. First, electrodes are glued to my back and a stim unit sends waves of electrical current to my midback down to the top of my glute on the left side. Spasticity can be painful and can make simple activities of daily.
As highlighted by gunel 2011 pediatric rehabilitation requires a multidisciplianary mdt approach in order to promote the independence of the child with an impairment, both functionally and psychologically and increase the quality of life of both the child and their family. It also generates muscle shortenings that influence bone growth and leads 3to deformities. First, the therapist has to evaluate the childs movement problems to create a treatment plan. Physical therapy regimens may include muscle stretching and. Spasticity is derived from the greek word spasticus, which means to pull. Spasticity should be treated when it causes pain, interferes with activities of daily living or sleep, or leads to less ability to function. After removing the cast, physical therapy is necessary to strengthen the muscles and improve the patients range of motion. Spasticity physical therapy management options if this is your first visit, be sure to check out the faq by clicking the link above. Treatments and therapies for spastic cerebral palsy cp. Spasticity results in muscle spasm and stiffness that may be painful and interfere with activities of daily living. Effect of quadriceps femoris muscle strengthening exercises. The surgical treatment may be traced back to otfrid foerster, who conceptualized posterior rhizotomy as a cure for spasticity in the first decade of the last century. Physiotherapists, viewed as the movement expert, play a key role within this mdt.
Controlling spasticity is crucial in the treatment of cp as it causes discomfort, gait abnormalities, and functional limitations. A multidisciplinary approach with a combination of medication and physical therapy should help guide the treatment of spasticity. Treatment goals spasticity interferes with daily activities, so the primary goal of treatment is to reduce the negative effects as much as possible. Your brain injury may cause the muscles in your body to become stiff, overactive, and difficult to stretch. Physical modalities cooling of muscles is beneficial in the management of spasticity. Physical therapies as an adjunct to botulinum toxina. Inhibit excessive tone as far as possible give the patient a sensation of normal position and normal movement facilitate normal movement patterns a. Patients and caregivers are taught to avoid certain postures that promote spasticity. A cast stabilizes the joint over a period of several weeks while the tendon regrows. Treatment is developed based on the patients needs, preferences and goals. Feb, 2017 to determine if physical treatment interventions are effective in preventing or minimising impairment, burden of care, patient quality of life and economic burden in those patients developing spasticity post stroke. Treatment may include such medications as baclofen, diazepam, tizanidine or clonazepam. Physical therapy refers to physical treatments or interventions that are provided by a range of clinicians rather than just those provided or overseen by a. Doctors call this effect spasticity pronounced spastisitee.
Physiotherapy treatment approaches for individuals with. There are certain physical and occupational therapy approaches, such as the. An sdr may be performed in selected patients with a goal to permanently diminishing spasticity. Role of physical therapist for management of spasticity cyberpt. It is also the dominant feature in several rarer conditions such as tropical and hereditary spastic paraparesis. This treatment, in addition to preventing contracture, has a lasting. Children with cp often experience movementrelated problems. When a muscle cant complete its full range of motion, the. Department of physical medicine and rehabilitation, stroke rehabilitation and comprehensive spasticity management, medical college of wisconsin, milwaukee, wi j.
Modified ashworth scale for physical therapyspasticity evaluation. Spasticity evaluation gillette childrens specialty. Spasticity treatment and research clinic and the uthealth motor recovery laboratory at tirr memorial hermann, houston, tx g. A treatment for individuals with severe spasticity due to. Symptomatic treatment of spasticity in multiple sclerosis. Consequently, understanding the effect of adjunct physical therapies will help inform multimodal. Jun 01, 2001 a widely used physical therapy intervention for children with cerebral palsy cp has been based on the bobath neurodevelopmental treatment ndt approach. The condition develops gradually, reaching its maximum extent long after the initial injury occurs. Spasticity can cause pain and abnormal posture, as well as difficulty with movement, selfcare, and other activities of daily living. Rehabilitation medicine, who can assess how spasticity affects daily activities. Archives of physical medicine and rehabilitation, 1004, 751768.
Baclofen pump for the treatment of spasticity dear patient and family, in the united states, an estimated 500,000 people have spasticity. Physical and occupational therapists play an important role in the evaluation, goal setting and management of patients with spasticity. Is not a measure of spasticity, but scores may by influenced by spasticity 2 is performed at one speed only onesecond1, so does not capture the velocitydependent component of spasticity good screening tool to indicate when further assessment needed 1. The physical therapy treatment involves passive exercise of the spastic muscles. Practical approaches to spasticity management iomsn. A person with spasticity may find it difficult to walk or perform certain tasks. Even if medications are not sufficient, interventional therapies should be coupled with rehabilitation to reduce spastic tone, facilitate a return of functional motor control, facilitate functional independence, and. Treating spasticity can improve function and quality of life after a stroke.
The traditional step ladder approach for treatment of spasticity involves. Health care providers consider the severity of spasticity, overall health and other factors to determine treatment, which may include. Identifying the physiological changes brought about by physical therapy or physiotherapy, is difficult. Physical therapy, who can assess the gross motor skills impacted by spasticity. Spasticity treatment requires a team approach and may involve a combination of exercise, physical therapy, medication or. Dec 17, 20 treatment for spasticity can range from physical therapy to medication to surgery, in severe cases. Spasticity of muscles is a common consequence of central nervous system impairment. Techniques used in physical therapy now finishing my second week, the therapist is using a number of effective techniques. To identify any adverse effects of physical treatment interventions for spasticity post stroke. Physiotherapists are part of the rehabilitation team involved in the management of adult spasticity. Spasticity may not be bothersome and does not always need treatment. Common causes of spasticity are cerebral palsy, brain injury, spinal cord injury, stroke and.
Developed by berta bobath, pt and karel bobath, md for functional recover. Botox can have some side effects, though, such as soreness, rash, trouble swallowing, and weak muscles. Since the root cause of spasticity lies in the brain and nervous system, rehabilitation starts there. Traditionally, neurological rehabilitation for spasticity has involved occupational and physical therapy. Plus, youll spasticity treatment exercises that relieve. Physical treatment interventions for managing spasticity. Bohannon6 showed that standing in a tilt table reduces spasticity after spinal cord. While there is usually no cure for the cause of the spasticity, but there are many treatment and management options that can offer relief and are proven ways to. Spasticity in children can result in growth problems, painful and deformed joints and disability.
Physical and pharmacological treatments can reduce pain and discomfort without compromising function spasticity is a common symptom seen in many neurological conditions, notably head injury, spinal cord injury, stroke, cerebral palsy, and multiple sclerosis. Summarize benefits of physical therapy for patients with ms. The study, published in the journal of physical therapy science, was titled effect of neurodevelopmental treatment based physical therapy on the change of muscle strength, spasticity, and gross motor function in children with spastic cerebral palsy. Currently, spasticity is managed in a variety of ways 2. Spasticity either injury to the brain or spinal cord can cause spasticity. Pdf spasticity is a disabling problem for many adults and children with a variety of neurological disorders. Rehabilitation therapies after botulinum toxina injection. Neurodevelopmental physical therapy improves spasticity. Spasticity can present variably in a clinical setting, spasticity can lead to many complications eg interference with daily function, hygiene, comfort, and nursing care as well as contractures increasing. Successful management of spasticity relies on a treatment plan that is based on accurate clinical patient assessment, 11 and using standardized measures is crucial. Physical therapy is one part of the armoury in the fight against this disabling symptom of the upper motor neurone syndrome. The approach to treating spasticity in children with cp is not standardized. Pdf spasticity is common in many neurological disorders, such as stroke and multiple sclerosis.
Treatment options for spasticity and related conditions, such as dystonia, cerebral palsy, and tremor, have advanced in recent years. Most common treatments for spasticity include oral medication and injections, however depending on the severity of your spasticity. Stretching helps maintain full range of motion and prevents permanent muscle shortening. S45s49 a number of different therapy interventions and modalities have been utilized in spasticity management. To determine if physical treatment interventions are effective in preventing or minimising impairment, burden of care, patient quality of life and economic burden in those patients developing spasticity post stroke. Treatment of spasticity by exposure to cold, physical therapy, volume 39, issue 9, 1 september 1959, pages 598599. This article examines the physiologic basis for the more common therapy interventions in the management of spasticity and discusses some of the literature that may help. Spasticity treatment exercises that relieve stiff muscles. Current practices of physical and occupational therapists. Jul 22, 2019 spasticity treatment exercises dont just target your muscles they help rewire your brain. Physical therapy is the mainstay of treatment for spasticity, and is designed to reduce muscle tone, maintain or improve range of motion and mobility, increase strength and coordination, and improve care and comfort. Surgical intervention that is used for the treatment of spasticity is called functional or. Physical therapy is different for every child with cerebral palsy. What are some nonmedical treatments for msrelated spasticity.