Weill Medical College of Cornell University

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Spasticity

Spasticity is a neuromuscular condition in which muscles are continuously contracted. Stiff or rigid muscles inhibit normal activity, including walking, movement, and speech. Spasticity in children has numerous potential causes, usually including injury to the nervous system, such as brain damage caused by lack of oxygen, brain trauma, stroke, or spinal cord injury. Certain metabolic disorders may also cause spasticity. When nervous system damage takes place before birth, the resulting nerve and muscle condition, including spasticity and loss of muscle control, is known as cerebral palsy. Neural damage causing spasticity is typically located in the cerebral cortex, the region of the brain that controls movement, or in the nerves that connect the brain to the spinal cord.

Symptoms

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 (scissoring), repetitive jerky movements (clonus), abnormal posture, and speech problems. These problems 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 muscle contracture, in which muscles shrink and lock joints in a single position.

Diagnosis

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

Treatment

There are several forms of treatment for spasticity. Physical therapy is important and will likely be required, involving a daily regimen of joint movement, exercise, and stretching that alleviates the severity of the symptoms. Physical therapy may also include fixing a joint with a cast or brace to oppose the spastic muscle.

In addition, a range of medications may be used. These medications are taken orally, but in severe chronic cases, a pump administering medicine directly to the fluid surrounding the spinal cord may be safely implanted for more effective delivery. Another form of commonly used treatment involves the injection of a specific fluid medication to loosen the spastic region.

The decision to treat spasticity surgically depends on the extent and severity of the condition and the child's other medical concerns. Often only one part of the body will be treated surgically because it will make specific movements necessary for daily living easier. Surgery for severe chronic spasticity includes orthopedic and neurological approaches. Orthopedic surgeries may involve altering tendon, muscle, and bone to restore movement and flexibility, used to maintain function as a child grows. Neurological surgeries include a procedure in which the nerves carrying sensory information to the spastic limbs are cut where they emerge from the spinal cord. This procedure is often used in children with cerebral palsy and has been shown to improve leg function.