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About the Pediatric Neurosurgery Fund
Conditions & Diagnoses
 
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> Spasticity
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Spasticity

Spasticity is a neuromuscular condition where muscles are continuously contracting. The stiff or rigid muscles inhibit normal activity, including walking, movement, and speech. There are numerous potential causes of spasticity including:
  • Brain damage caused by a lack of oxygen
  • Brain trauma
  • Stroke
  • Spinal cord injury
Certain metabolic disorders may also cause spasticity. When nervous system damage takes place before birth, the resulting nerve and muscle problems, including spasticity and loss of muscle control, are known as cerebral palsy. The neural damage that causes spasticity typically takes place in the cerebral cortex, the region of the brain that controls movement, or the nerves that travel from the brain to the spinal cord.

What are the symptoms of Spasticity?

Spasticity can take many forms including:
  • Inability to bend limbs because of overactive deep tendon reflexes
  • Joints that stay bent at unusual angles
  • Crossing of the arms or legs (called scissoring)
  • Repetitive jerky / beating movements (called clonus)
  • Abnormal posture / arching
  • Speech or language problems
These problems also vary in severity, from mild muscle stiffness and increased muscle tone to painful, uncontrollable, and debilitating muscle spasms. Long-term spasticity can result in permanent contracture of muscles, in which muscles shrink and lock joints in a single position.

How is Spasticity diagnosed?

A complete physical examination and neurological testing are necessary to assess the extent of spasticity. Physical and occupational therapists will also examine the child to determine exactly which muscles are involved.

Treatment of Spasticity

There are several forms of treatment for spasticity. Physical and occupational therapy are important treatments that likely will be required regardless of other treatment choices. This involves a daily regimen, which parents can do at home with their children, of joint movement, exercise and stretching that alleviates the severity of the symptoms. Therapy also may include fixing a joint with a cast or brace (orthotics) to oppose the spastic muscle.

Additionally, a range of medications, including baclofen, tizanidine, benzodiazepines, and dantrolene sodium, may be used. These medications are taken orally but in severe chronic cases, a pump is inserted by a neurosurgeon that administers baclofen directly to the fluid that surrounds the spinal cord may be surgically implanted. Another form of treatment commonly used involves the injection of Botox (botulinum toxin type A) to relax the muscles of the spastic region.

Orthopedic surgeries may involve altering tendons, muscles and bones to restore movement and flexibility. These approaches may be done in children to maintain function as a child grows.

Neurological surgeons employ another type of procedure called selective dorsal rhizotomy, in which the nerves that carry sensory information to the spastic limbs are cut where they emerge from the spinal cord. These nerves play a key role in the generation of spasticity. The procedure is often used in children with cerebral palsy and has been shown to improve leg function. The decision to treat spasticity surgically depends on the extent and severity of the condition and the child’s other medical concerns. Intensive rehabilitation is required following a selective dorsal rhizotomy.