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Module 2: Nonsurgical management of Spasticity
Rajiv Reebye1, Alexander Balbert2, Djamel Bensmail3, Heather Walker4, Jörg Wissel5, Thierry Deltombe6, Gerard E Francisco7
1 Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver BC, Canada
2 Department of Adaptive Physical Training, Ural University of Physical Education, Sverdlovsk Regional Hospital for War Veterans, Yekaterinburg, Russia
3 Department of Physical Medicine and Rehabilitation, R. Poincaré Hospital, Assistance publique - Hôpitaux de Paris, University of Versailles Saint Quentin, Garches, France
4 MUSC Health Rehabilitation Hospital, An Affiliate of Encompass Health, North and Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA
5 Department of Neurological Rehabilitation and Physical Therapy, Vivantes Hospital Spandau, Berlin, Germany
6 Department of Physical Medicine and Rehabilitation, Université catholique de Louvain, Centre Hospitalier Universitaire de Namur, Godinne Site, Avenue Docteur G Therasse, Yvoir, Belgium
7 Department of Physical Medicine and Rehabilitation, UTHealth Houston McGovern Medical School and TIRR Memorial Hermann Hospital, Houston, Texas, USA
Correspondence Address:
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2349-7904.347808
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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.
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