Spasticity management according to level of severity
Mild spasticity | Emphasis on self management, education, and how to seek help to prevent secondary complications |
• Clonus or mild increase in tone | • Highlight potential trigger factors |
• No or minimal loss of range | • Education of secondary complications |
• Mild spasms; generally not problematic or affecting function but annoying or inconvenient | • Stretches: neurophysiotherapist identifies vulnerable areas and recommends specific, active, and regular stretches |
• Discuss ways of maintaining active movement and modify patterns of movement to minimise increasing spasticity | |
• Low dose drug treatment targeted at problematic times of the day, with ongoing review and evaluation, maybe beneficial | |
Moderate spasticity | Emphasis on early identification and treatment of trigger factors, review of self management knowledge, and liaison with team members involved throughout the different health care sectors; maximise the use of oral drugs and consider the use of botulinum toxin if focal |
• Loss of range of movement and possible contracture | • Identify trigger factors and treat as appropriate |
• Walking is often effortful, may require aid or wheelchair | • Targeted neurophysiotherapy; active stretching, exercise and standing programmes; consider splinting |
• Difficulty releasing grip or in hand hygiene | • Maximise available activity to have a positive impact on function and establish extent to which spasticity and spasms are used to enable effective movement; consider rehabilitation |
• Minor adaptations required for position in lying; t-roll, wedge, pillows, lumbar roll | • Accurately document assessments and treatments to enable ongoing evaluation of intervention |
• Maximise oral drugs and consider if botulinum toxin could be helpful for focal spasticity | |
• Consider referral to specialist service | |
Severe spasticity | Emphasis on maximising use of oral and focal drug treatments while considering use of intrathecal baclofen or phenol; review patient’s, carers’ and health team management strategies |
• Marked increase in tone | • Identify trigger factors and treat as appropriate |
• Loss of range and probable contracture | • Accurately document assessments and treatments to enable ongoing evaluation of intervention |
• Often hoisted for transfers | • Assess effectiveness of current treatment strategies, modify as appropriate, and consider intrathecal drugs |
• Difficult positioning despite complex seating systems | • If intrathecal drugs are used, review need to reassess seating, transfers, and therapy input; consider rehabilitation |
• Reduced skin integrity | • If treatments are or become ineffective, review management strategies including possibility of surgery |
• Often reliant on a catheter and regular enemas | • Identify trigger factors and treat as appropriate |
• Accurately document assessments and treatments to enable ongoing evaluation of intervention | |
• Assess effectiveness of current treatment strategies, modify as appropriate, and consider intrathecal drugs | |
• If intrathecal drugs are used, review need to reassess seating, transfers, and therapy input; consider rehabilitation | |
• If treatments are or become ineffective, review management strategies including possibility of surgery |