General principles of spasticity management

The management of spasticity is determined by whether you are dealing with focal or general spasticity. Treatment decisions will for the most part be predicated on this. Before considering specific interventions, it is essential that factors that can exacerbate the spasticity be treated or managed. Potentially, nociceptive stimulus can exacerbate spasticity. These include factors such as pressure areas, ingrown toenails, heterotopic ossification, fractures, bladder or bowel distention, and postural abnormalities.7' 11 Once the decision to treat the spasticity has been made, then irrespective of the nature of the spasticity, the mainstay of management is good and appropriate physical treatment.13,1415 Expert physical therapy is essential and forms the basis of management. The most important physical approach is muscle stretching and, where appropriate, muscle and joint splinting16 to maintain range of movement and to prevent the development of contractures.9,17 Physical modalities, including ultrasound diathermy and local heat and local cold therapy, may assist in joint and muscle flexibility. Passive stretch to assist in spasticity management and the prevention of contractures is essential. Hydrotherapy is often beneficial in spasticity management allowing a combination of supported weight bearing and local heat.

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