Spasticity

Last modified by Hussein Abdallah on 2025/04/23 19:12

FACTS

spasticity = (1) too much excitatory afferent impulses and (2) too little inhibitory input from basal ganglia and cerebellum.

most commonly seen in CP (up to 60%)
othre etiologies: head injury, strokes, SCI
does not generally worsen with time (Although families may notice it more with expected development). this is contrast to dystonia because that DOES increase with time.

- the two surgical solutions for spasticity come down to the etiology

1) excitatory afferent impulses --> selective dorsal rhizotomy to decrease excitatory input

2) lack of inhibitory input from basal ganglia and cerebellum --> intrathecal baclofen (GABA agonist) to increase inhibitory input

[ ] Surgery generally considered for Ashworth levels 2+. You want to intervene before contractures have begun.

[ ] Multidisciplinary medical treatment with neurology, PMR, OT, SLP

[ ] Orthopedic supportive intervention includes muscle/tendon lengthening/transfer, corrective osteotomies, joint stabilization

Modified Ashworth Score	Description
0	no increase in tone
1	slight increase in tone
1+	slight increase in tone + catch + minimal resistance through < 50% ROM
2	marked increase in tone resistance through most
3	considerable increase in muscle tone, difficult movement even passively
4	rigid flexion + extension