Spasticity Management in Cerebral Palsy

About Spasticity Management

At Rady Children’s Hospital-San Diego, our multidisciplinary team specializes in the comprehensive management of spasticity in children with cerebral palsy. Our approach integrates personalized care plans tailored to each child’s specific needs to improve their overall function and quality of life.

What is Spasticity?

Spasticity refers to a condition characterized by tight or stiff muscles that interfere with normal movement, speech, and gait. It is common in children with cerebral palsy and results from damage or disruption of nerve pathways within the brain or spinal cord.

Signs and Symptoms

• Tight or stiff muscles
• Difficulty controlling muscle movement
• Exaggerated muscle reflexes
• Involuntary muscle spasms
• Difficulty with posture and positioning

Diagnosis and Evaluation

Our expert team at Rady Children’s Hospital uses comprehensive evaluations to diagnose spasticity and determine its severity and impact on daily activities. Evaluations typically include:

• Clinical assessments by specialists
• Gait analysis
• Advanced imaging studies, such as MRI
• Functional assessments of mobility and daily activities

Treatment and Management Options

Management of spasticity requires individualized, multidisciplinary treatment plans. At Rady Children’s, our strategies include:

Non-Surgical Treatments:

• Physical Therapy: Strengthening, stretching, and improving functional mobility.
• Occupational Therapy: Improving daily living skills, fine motor skills, and independence.
• Orthotics and Equipment: Braces, splints, and assistive devices to improve positioning and mobility.
• Oral Medications:
  May be helpful for patients with spasticity in many muscles that interferes with function, comfort, or care. These medications are often the first choice in spasticity management as they are safe and usually well-tolerated; however, they are not effective in all patients. The most common side effect of these medications is drowsiness.

Advanced Interventions

• Botulinum Toxin Injections:
  Such as Botox® and Dysport®, injected directly into spastic muscles to weaken them by blocking transmission between the nerve and the muscle. It works best when spasticity is a problem in only a few muscles. Examples include injection into the calf to decrease toe walking or the groin muscles to decrease scissoring (crossing of the legs). It is used when full range of motion is present and is not effective when the joint cannot move due to a shortened muscle (contracture). The effects of botulinum toxin injections usually last four to six months, and treatment needs to be repeated in many patients.
• Intrathecal Baclofen Therapy (ITB) / Intrathecal Baclofen Pump:
  This delivers baclofen (one of the most common spasticity medications) directly into the fluid around the spinal cord. A small battery-operated pump is placed under the skin on the person’s trunk during surgery. The pump is connected to a small tube that delivers baclofen, which decreases spasticity throughout the body without causing drowsiness. Intrathecal baclofen pumps work best for children and adults with cerebral palsy who have spasticity in many muscles. The pump needs to be refilled regularly at clinic visits. An advantage is the ability to alter the dosage as needed.
• Surgical Interventions:
  • Selective Dorsal Rhizotomy (SDR):
    Also referred to as a Selective Posterior Rhizotomy, SDR is a neurosurgical procedure where a portion of the sensory nerves entering the spinal cord are cut to eliminate spastic reflexes. This procedure works best in younger children who can walk but have significant spasticity in their legs. Since the surgery may uncover weakness hidden by spasticity, it is important that the child demonstrates good strength and the ability to control muscles before surgery. Physical therapy is required afterward to improve strength and adapt to reduced spasticity. SDR can also be helpful for individuals who don’t walk but have severe spasticity that interferes with positioning, comfort, and care.
  • Orthopedic Surgery: Procedures to correct deformities, improve function, and enhance comfort and mobility.

Dystonia and Choreo-Athetosis

While a majority of people with cerebral palsy have spasticity, a small percentage have involuntary movement disorders including dystonia and choreo-athetosis. Muscle stiffness can be associated with dystonia. Not all treatments designed to reduce spasticity are effective in addressing these movement disorders; it is important that the type of muscle stiffness be evaluated by an experienced team.

Deep brain stimulation, or DBS, has recently been used for some people with cerebral palsy who have dystonia or choreo-athetosis. DBS is often described as a “brain pacemaker,” as it uses electrodes that are strategically placed in the brain to ease the symptoms of movement disorders. The pacemaker includes a chest-implanted generator that sends continuous pulses to the brain. Just as the heart pacemaker helps to correct an abnormal heart rhythm, the brain pacemaker uses these pulses to correct the abnormal activity in the brain.

Why Choose Rady Children’s Hospital for Spasticity Management?

Rady Children’s offers compassionate, comprehensive care from diagnosis through long-term management. Our multidisciplinary team collaborates to ensure personalized, evidence-based treatment, optimizing your child’s quality of life and functional abilities. We prioritize family involvement, education, and support throughout your child’s care journey.