Spasticity

Abstract

This chapter reviews the aetiology, pathophysiology, assessment, and treatment of spasticity in adults and children. We present an overview of the medical management options as well as the multidisciplinary input and rehabilitation required. Surgical interventions are then outlined with more sections on neurosurgery, plastic surgery, and orthopaedic surgery. The mainstay of neurosurgical treatment has traditionally involved intrathecal baclofen, however, there is now a renewed focus on the role of selective dorsal rhizotomy for the more mobile children. Both these surgical techniques are explained and discussed. Plastic surgery intervention with selective peripheral neurotomy and splinting is then described. In addition, orthopaedic surgery (single event multilevel surgery and bone/joint reconstruction) is discussed in outline. Finally, a brief overview of current controversies is also presented. Carefully planned and coordinated multidisciplinary team care is vital to ensure patients have appropriately-tailored treatment to maximize their potential and limit the deleterious effects of spasticity.