Focal Management of Spasticity in Cerebral Palsy

Abstract

Spasticity is the most common presentation of all neurologic alterations in children with CP. When the neurologic system loses motor control function and postural stability or weakens but has organizational ability to functionally respond, it will increase muscle tone to compensate. However, there are cases where this response over reacts and it develops pathologic spasticity which causes impairment. Therefore, when treating children with spasticity, the basic supposition is that muscle tone is good and the amount of muscle tone should be modulated for the individual’s maximum benefit. Spasticity may be generalized affecting almost all the muscular system, and generalized increase in tone may be associated with mixed tone conditions where it is combined with movement disorders. The spasticity for these individuals may be very beneficial to modulate the movement disorder. Treatments for generalized spasticity require an approach that reduces whole body tone. Children with diplegia often have more localized spasticity problems such as the plantar flexors but may also involve the whole lower extremities. Management options include whole body methods. In children with hemiplegia or unilateral CP, the spasticity tends to be localized to a single side, and the treatment should be more focused on the local problem. There are many treatment options for spasticity including those that affect the whole body to those that have a very localized affect. Some of the treatments also are permanent and cannot be reversed, while others are temporary whose effect disappears when the treatment ends. The remaining discussion in this chapter will focus on the localized effects of spasticity and localized treatments of spasticity