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Spasticity Management Program

  • Physiatrists are rehabilitation medicine specialists who are experts in treating spasticity. They prescribe therapies and equipment that may be beneficial to patients after their spasticity is controlled.

    Spasticity is involuntary muscle movement that occurs when communication between the brain and the spinal cord is disrupted due to illness or injury in the nervous system.

    The brain can no longer send signals that inhibit or moderate muscle tone, so muscle tone is "turned on at high volume" and is easily stimulated by movement or irritation.

    Spasticity can develop immediately after an injury or several weeks later. It can pose a barrier to voluntary movement, cause pain, or interfere with self care, safety and mobility.

    Spasticity can often be controlled with oral medications such as Baclofen (Lioresal), Zanaflex, Valium and Dantrium.

    With improved management of spasticity, therapists and patients can work to increase range of motion and possibly strengthen muscles previously overwhelmed by the spastic muscles.

    However, when these medications are insufficient or cause side effects like sedation, confusion, liver toxicity or excessive weakness, other methods can be used.

    Injecting the muscle with small amounts of Botox temporarily decreases signals to the muscle that cause spasticity.

    Physicians at Courage Kenny Rehabilitation Institute complete this procedure in the clinic and benefits can last about eight to twelve weeks.

    This technique is used when spasticity affects primarily one limb or decreases movement in one joint, such as spastic wrist or tight finger flexor muscles that cause fisting and decreased hand use in stroke patients.

    Severe spasticity

    For people with severe spasticity who cannot get relief of their spasticity or have undesirable side effects from oral medications, physicians may implant a pump that delivers antispasticity medication 24 hours a day.

    The medication travels directly to the spinal cord via its surrounding fluid. After a successful test dose is completed, a neurosurgeon or anesthesiologist implants the pump (made by Medtronic) under the skin.

    A tiny tube or catheter is inserted under the skin and enters into the spinal canal at a predetermined level. This allows the medication to surround the spinal cord and target the cells that cause spasticity.

    Because the medication is delivery locally and in significantly smaller amounts, the patient does not typically experience the negative side effects that they may encounter with taking oral medications.

    By the time the fluid gets to the brain, most of the medication (delivered in microscopic amounts) is used up; thus the patient does not usually have side effects that they may encounter with taking pills.

    Like a pacemaker, the pump can be reprogrammed by an external device, and is refilled by a small needle every four to twelve weeks at the clinic.

    The dose can be changed in microgram amounts and can be adjusted for different times of the day. For example, a pump could be programmed to deliver more baclofen at night and less during the day to best meet a patient's needs.

    With use of a baclofen pump, patients often experience decreased pain due to spasms and some patients can stop all or most of their oral antispasticity drugs.

  • Source: Courage Kenny Rehabilitation Institute
    Reviewed by: Rebecca Weber, CNP
    First published: 03/22/2011
    Last reviewed: 03/01/2011