What is Spasticity?

Spasticity is a condition in which muscles become stiff, tense and difficult to move at times. The effects of spasticity can range from minor to severe.

About 80% of children who have cerebral palsy (CP) have some degree of spasticity. Cerebral palsy usually develops because of brain damage that happens during the early stages of brain development. This damage can happen before, during or after birth up to the age of 3. Cerebral palsy causes problems in communication from the brain to nerves and muscles. Due to brain damage, the messages that are sent out are not clear. The muscles then respond in the wrong ways. This causes spasticity, with the affected muscles becoming stiff, tense, weak and/or difficult to control.

Spasticity also can affect anyone who has experienced:

• Traumatic brain injury
• Spinal cord injury
• Stroke
• Another central nervous system injury

There is no cure for spasticity. But many treatment options are available to help address pain and improve movement, positioning and ease of care.

Challenges That May Result from Spasticity

Spasticity may affect a child’s ability to do certain motor tasks. It can cause pain and discomfort. This can make self-care difficult or lead to poor posture. Some children may have spasticity on one side of the body or both. The condition can affect just the legs or the entire body. It depends on where the original nervous system injury occurred.

Children with spasticity may have difficulty with activities of daily life, such as:

• Walking
• Eating and swallowing
• Speaking clearly
• Picking up small objects or other fine motor skills
• Positioning themselves comfortably in a chair or wheelchair

Many children with spasticity have additional health issues, such as:

• A movement disorder called dystonia. This causes involuntary movements such as twisting and abnormal postures. Dystonia can affect one muscle, a muscle group or the entire body.
• Musculoskeletal problems, such as shortening of muscles and tendons as a child grows (called contractures). This can cause a loss of range of motion.
• Joint and bone abnormalities
• Scoliosis (curved spine)
• Poor control of movements

Spasticity Diagnosis

Spasticity may be seen in the first year of life. Many times, it becomes more apparent after age 1. Spasticity can also develop at any age after an injury, tumor or other forms of damage to the brain or spinal cord.

To diagnose spasticity, your child’s doctor will perform a physical exam with neurological testing. Diagnosing spasticity is a straightforward process. Doctors who specialize in this area of medicine usually can do so during the first visit.

Spasticity Treatment

The goal of treatment for spasticity is reduce the spasticity. This lets the child gain better motor control, improved function and increased comfort (less pain). Children with spasticity may have many types of treatment throughout their lives.

Some types of treatment focus on the communication problems between the brain and muscles. Spasticity occurs because the brain is continually sending messages to the muscles, telling them to contract. Treatment can block, reduce or slow down these messages to create more balance in the nervous system.

A child’s treatment plan may include:

• Medications — such as baclofen, diazepam or tizanidine — to reduce spasticity. These can improve ease of movement, reduce pain and relax muscles.
• Botulinum toxin injections, such as Botox, to reduce spasticity. These injections provide three to five months of relief at a time. Children can have multiple injections.
• Intrathecal Baclofen pump therapy, which delivers muscle-relaxing baclofen directly to the spinal cord for spasticity control.
• Selective dorsal rhizotomy (SDR), which involves cutting nerves in the lower spinal cord that are causing spasticity.

Other types of treatment don’t address the underlying causes of spasticity. But they may promote better function, mobility and comfort.

• Bracing to maintain range of motion and improve positioning and movement
• Casting to reduce contractures and increase range of motion
• Physical therapy to promote strength, range of motion, mobility and other functions
• Occupational therapy to help children gain independence with daily tasks at home and school and to improve upper extremity function
• Speech therapy to help children improve their communication, speech, eating and swallowing skills
• Orthopaedic surgery to address problems such as joint alignment, hip dislocation, scoliosis and difficulties with walking or fine motor skills. Orthopaedic surgeons use minimally invasive techniques and often do multiple procedures at once, rather than spacing them out over many years. This approach is called “single-event, multilevel surgery” (SEMLS), and it usually results in fewer surgeries overall.

Some examples of orthopaedic surgery for spasticity are:

Soft tissue surgery

• Transferring a tendon from one part of the body to another to support better movement
• Lengthening a muscle to relieve tightness in any joint of the arms or legs

Bony structures surgery

• Osteotomy (cutting of bone) to correct a joint or bone problem
• Joint fusion to provide long-term support for a severely affected joint

Spasticity Long-Term Outlook

Severe spasticity can impact a child’s quality of life and lead to problems with bones, joints and muscles as a child grows. But even mild forms of spasticity can affect a child’s life.

That’s why working closely with a team of specialists who are experts in treating spasticity is essential. This type of care offers your child the best opportunity for comfort, improved function and movement, and more independence.