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 | |