Spasticity, Dystonia, and Athetosis Management in the Upper Extremity in Cerebral Palsy

Abstract

Upper extremity disability from cerebral palsy (CP) in both children and adults has multiple aspects to the impairment. Increasemuscle spasticity and movement disorder are very common and may be predominating symptoms of the impaired limb. It should be noted, however, that these are often combined with muscle contractures, decreased selective motor control, impaired sensibility, and overall ignoring the limb. The topic of upper extremity spasticity has received as much or more attention than lower extremity spasticity in CP. There are multiple mechanisms for assessing spasticity, which is an issue that continues to be unresolved. In addition to spasticity, movement disorders both athetosis and dystonia are relatively common manifestations of the upper extremity impairment. Treatment for upper extremity spasticity includes many different modalities from oral medication, botulinumtoxin injection, electrical stimulation, neurectomy, therapy, and transcranial stimulation. Treatment for movement disorders includes oral medication, intrathecal baclofen, and deep brain stimulation. For the whole population of all children with cerebral palsy, approximately 60% have significant upper extremity disability. The vast majority of these are individuals with spasticity; however approximately 20% also report dyskinetic movement disorders in the upper extremity. The goal for this chapter is to define the treatment options for spasticity and movement disorders in the upper extremity of individuals with CP. The risks, complications, and longer-term expectations of these management strategies will also be discussed.