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Spasticity Treatment

Treatment and Management Options for Spasticity

Several different types of treatment for spasticity are available, including medication, physical therapy, injections and surgery. Each treatment option is evaluated based on the underlying cause, age of the patient and severity of the spasticity. All treatment options are designed to relieve the signs and symptoms of spasticity, reduce pain and frequency of muscle contractions and improve voluntary muscular function.

How Is Spasticity Diagnosed?

In order to confirm spasticity, physicians will first evaluate your medical history including any history of neurological or muscular disorders in your family. Additionally, there are several tests doctors can do involving specific movements of the arms and legs, muscular activity, range of motion and the ability to perform self-care activities

Oral Baclofen or Muscle Relaxants

Oral medication, the least invasive treatment, may be used to relax stiff or contracted muscles. These drugs may not always be effective and have side effects ranging from drowsiness and changes in blood pressure to the risk of liver damage, so their use requires continuous monitoring. Oral medications are most appropriate for children who need only mild reduction in muscle tone or who have widespread spasticity.

Botulinum Toxin (Botox®)

Botox, administered by local injection, relaxes contracted muscles by keeping nerve cells from overactivating them. Muscle relaxation occurs within days and peaks after a month, with the effect lasting three to four months. This treatment requires repeated injections.

Intrathecal Baclofen (ITB)

An implanted programmable pump infuses baclofen directly into the patient’s spinal fluid via a catheter inserted into the spinal canal. The pump requires periodic replacement and can be removed. This treatment requires refilling of the pump and frequent monitoring to ensure the appropriate dosage is dispensed; failure of the pump poses a risk of life-threatening withdrawal. ITB is usually used in spastic quadriplegics (where both arms and legs are affected) with poor trunk control and who have had multiple orthopedic surgeries and are unable to become independent walkers.

Selective Dorsal Rhizotomy (SDR)

Selective dorsal rhizotomy can provide an immediate, permanent reduction in spasticity and the potential to walk independently within one to two years with intensive postoperative physical and occupational therapy. A young patient with a strong commitment to succeed can achieve independent walking.

SDR is most effective for patients two to 40 years of age with spastic diplegia or spastic hemiplegia who have good trunk control and have not had multiple orthopedic procedures.

The surgical procedure requires a one-level laminectomy, where the spinal canal is unroofed at one level in the mid-lower back. Next, the dorsal sensory nerve roots are exposed. They are divided into rootlets and tested one by one with around 75 percent of the most spastic rootlets cut. Overall, surgery takes about two and a half hours with five total days in the hospital. The postoperative mobility results are excellent in the right patients. Learn more about this surgical procedure ».

Physical Therapy and Rehabilitation for Spasticity

Physical therapy focuses on stretching the muscles along with range-of-motion exercises to improve muscular function and alleviate symptoms of spasticity. Braces may also be used in conjunction with physical therapy to prevent the shortening of tendons.

At TIRR Memorial Hermann, we have an affiliated team of Physical, Medicine & Rehabilitation (PM&R) specialists trained to help each patient with injuries or illnesses that affect movement achieve an improved quality of life and functional efficiency and decrease pain with the goal of enabling each patient to live the most independent life possible.  

The affiliated neurologists and neurosurgeons at the Texas Comprehensive Spasticity Center at Children’s Memorial Hermann Hospital provide effective treatments for children with spasticity. They offer innovative solutions such as selective dorsal rhizotomy (SDR), which can provide an immediate, permanent reduction in spasticity and the potential to walk independently within one to two years This comprehensive team provides medical management and innovative treatments using baclofen pumps, botulinum toxin (Botox®), specialized surgery along with the ongoing support that leads to superior outcomes.

TIRR Memorial Hermann manages the symptoms of spasticity with the expertise of a well-integrated team of clinicians. One treatment option is the use of medications injected directly into the spastic muscle such as phenol and botulinum toxin (Botox®). This treatment is used in conjunction with casting, splinting and orthotic management. TIRR Memorial Hermann performs assessments and provides rehabilitation around the intrathecal Baclofen pump, a mechanical device that is surgically implanted and delivers medication directly into the brain and spinal cord.