Spasticity

What Is Spasticity, and How Is It Treated?

Spasticity is a muscle control disorder. It causes an increase in muscle tone and stiffness. It can be painful and lead to difficulty moving and talking. Spasticity cannot be cured, but some of the symptoms of spasticity can be treated.

The Spasticity Program at Children’s Healthcare of Atlanta offers a multidisciplinary approach to reduce and control spasticity. Each child is individually evaluated by a neurologist, neurosurgeon, orthopedic surgeon and physical therapist. The specialists then discuss which treatment or combination of treatments would best benefit each child.

• Baclofen pump therapy
• Botox injection therapy
• Orthopedic management of spasticity

Each of these treatment options is supported by a comprehensive physical rehabilitation therapy program.

Physical and occupational therapy

As more treatments become available for children with spasticity, rehabilitation has become even more important. At Children’s, our physical and occupational therapists create individualized treatment plans that may include strengthening exercises, joint mobilization or ultrasound to help improve a child’s mobility. They also examine how a child performs a variety of functions and tasks to help make sure the child is maintaining and increasing coordination.

Baclofen pump therapy

Baclofen is a drug used to relax muscles. It delivers the drug only to the nerves that control a child’s muscles. The pump is a mechanical device surgically implanted on the stomach’s abdominal wall. It is connected to a small tube implanted in the spinal canal. The pump delivers a specific amount of baclofen to the nerves in the spinal cord. The dosage can be adjusted nonsurgically by a neurologist.

At Children’s, patients undergo a drug trial to test the potential benefits of baclofen pump therapy. Your child will be admitted to the hospital, where baclofen will be injected through a spinal needle. A neurologist and physical therapist will evaluate your child before and after the injection. If the drug treatment is successful, surgical pump placement will be recommended.

While baclofen is good at reducing overall tone and spasticity, the tone reduction is not specific. All muscles will have reduced tone. When a child’s muscles are so stiff that a child is difficult to position and care for, the baclofen pump is very useful. It may also be beneficial in improving your child’s upper extremity function by increasing his range of independent motion.

Botox injection therapy

Botox is a purified form of botulinum toxin—a toxin found in contaminated food. When eaten, the toxin produces a condition called botulism that causes profound muscle weakness. This toxin is effective in the treatment of spasticity when used selectively. Botox can treat focused areas of spasticity. Spastic muscles are selectively weakened through the injection of small amounts of Botox. It can be used in any muscle group but is most effective in smaller muscles.

After evaluation of the potential risks and benefits by the Children’s Spasticity Program team, patients are sedated, and injections are administered in precise points. Precision in injection placement makes the procedure more effective. The muscles are usually weak within two to three days, and the effect lasts two to six months.

Orthopedic management of spasticity

For some children, surgery performed on the bones, joints, muscles and tendons improves function. Orthopedic surgeons at Children’s can selectively lengthen tight, spastic muscles to balance their strength with normal muscles. This produces a smoother gait and limits the harmful effects of spasticity, such as joint deformity. At times, orthopedic surgery may be required to treat fixed deformities in the hips, knees or ankles.

Orthopedic surgery works best when there is a fixed deformity in the limbs. It can weaken muscles regardless of their size and strength. After surgery, a child often wears a cast while the bone and soft tissue heals.

In addition to muscle lengthening surgery, orthopedic management of spasticity includes:

• Joint contracture releases to allow greater range of motion.
• Spinal fusions to provide functional posture in children with poor trunk control related to muscle tightness.
• Femoral or pelvic osteotomy to keep the hip joint intact in children whose muscle contractures pull the hip bone out of the hip socket.
• Seating and other mobility devices to enable children to be as mobile and functional as possible.
• Orthotics and bracing to maintain proper positioning of a joint.