Module 2

Abstract

Spasticity management should be part of a well-coordinated and comprehensive rehabilitation program that is patient-centric and goal-specific. There are a variety of options available for the treatment of spasticity. A usual approach is starting with the least invasive treatment modalities initially and gradually increasing to more complex interventions as this is required. This curriculum considers oral antispasticity drugs in terms of mechanism of action, clinical use, efficacy, and adverse events. It also presents other treatment options, such as chemical neurolysis using phenol and alcohol and chemodenervation using botulinum toxin A (BoNT-A). Therapeutic intramuscular injections of BoNT-A require sound patient selection, accurate muscle selection, and precise localization. The common methods for achieving these are described. The importance of physiotherapy is explained, along with the necessity to combine treatment modalities to address spasticity and the various components of the upper motor neuron syndrome. Recognizing differences in various health-care systems across countries and regions, the authors aim to present various treatment options. While this section of the curriculum highlights the importance of an interdisciplinary effort in managing spasticity, it is understandable that not all treatment options are available uniformly. The challenge to clinicians is to make the most of the management options on hand to optimize outcomes.

Intrathecal Baclofen Therapy and the Role of the Rehabilitation Nurse

“…Stretching and range of motion prior to activities or scheduled throughout the day can help improve function and make mobility or self-care of the person with spasticity easier to perform. However, in muscles with increased tone, the shortening of the muscles and connective tissues usually recurs unless the muscle stretch is maintained over time (Reebye et al, 2022). Rehabilitation nurses may assist in applying casts or splints fabricated in therapy to help maintain that prolonged stretch.…”

“…The pump delivers micrograms of medication, which is only 1% of the oral dose of milligrams resulting in much less somnolence from the medication. Baclofen is a gamma aminobutyric acid (GABA) analog that binds to the GABA-B receptors in the spinal cord to release excitatory neurotransmitters and decrease motor neuron firing thus decreasing muscle spasms (Balaratnam & Stevenson, 2022; Reebye et al, 2022). The intrathecal baclofen delivered in the pump is titrated based on the person’s physical and verbal responses.…”

Assessing muscle architecture with ultrasound: implications for spasticity

“… 15 Muscle and soft tissues are often targeted by different spasticity treatments. 16 Thus, further elucidating the relationship between muscle changes and spasticity manifestation may better inform treatment.…”