Spasticity is a muscle control disorder. It causes an increase in muscle tone and stiffness. It can be painful and lead to difficulty moving and talking. Spasticity cannot be cured, but some of the symptoms of spasticity can be treated.
The Spasticity Program at Children’s offers a multidisciplinary approach to reduce and control spasticity. Each child is individually evaluated by a neurologist, a neurosurgeon, an orthopaedic surgeon and a physical therapist. The specialists then discuss which treatment or combination of treatment s would best benefit each child. Treatments include:
- Baclofen pump therapy
- BOTOX injection therapy
- Orthopaedic management of spasticity
Each of these treatment options is supported by a comprehensive physical rehab therapy program.
Physical and occupational therapyAs more treatments become available for children with spasticity, rehab has become even more important. At Children’s, therapists work with neurologists, neurosurgeons and orthopaedic surgeons to evaluate the best treatment program for each child. Within each individualized treatment plan, physical and occupational therapy are essential.
Baclofen pump therapyBaclofen is a drug used to relax muscles. The baclofen pump delivers the drug only to the nerves that control the child's muscles. The pump is a mechanical device surgically implanted on the stomach’s abdominal wall. The pump is connected to a small tube implanted in the spinal canal. The pump delivers a specific amount of baclofen to the nerves in the spinal cord. The dosage can be adjusted non-surgically by a neurologist.
At Children's, patients undergo a drug trial to test the potential benefits of the pump. The child is admitted to the hospital where baclofen is injected through a spinal needle. A neurologist and physical therapist evaluate the child both before and after the injection. If the drug treatment is successful, surgical pump placement is recommended.
While baclofen is good at reducing overall tone and spasticity, the tone reduction is not specific. All muscles will have reduced tone. When a child's muscles are so stiff that the child is difficult to position and care for, the baclofen pump is very useful. It may also be beneficial in improving the child's upper extremity function by increasing the child's range of independent motion.
BOTOX injection therapyBOTOX is a purified form of botulinum toxin—a toxin found in contaminated food. When eaten, the toxin produces a condition called botulism, which causes profound muscle weakness. This toxin is effective in the treatment of spasticity when used selectively. BOTOX can treat focused areas of spasticity. Spastic muscles are selectively weakened through the injection of small amounts of the toxin. BOTOX can be used in any muscle group, but is most effective in smaller muscles.
After evaluation of the potential risks and benefits by the Children's spasticity team, patients are sedated and the injections are administered to precise points. Precision in injection placement makes the procedure more effective. The muscles are usually weak within two to three days and the effect lasts two to six months.
Orthopaedic management of spasticity
For some children, surgery performed on the bones, joints, muscles and tendons improves function. Orthopaedic surgeons at Children’s can selectively lengthen tight, spastic muscles to balance their strength with normal muscles. This produces a smoother gait and limits the harmful effects of spasticity, such as joint deformity. At times, orthopaedic surgery may be required to treat fixed deformity in the hips, knees or ankles.
Orthopaedic surgery works best when there is a fixed deformity in the limbs. It can weaken muscles regardless of their size and strength. After surgery, a child often wears a cast while the bone and soft tissue heals.
In addition to muscle lengthening surgery, orthopaedic management of spasticity includes:
- Joint contracture release to allow greater range of motion
- Spinal fusions to provide functional posture in children with poor trunk control related to muscle tightness
- Femoral or pelvic osteotomy to keep the hip joint intact in children whose muscle contractures pull the hip bone out of the hip socket
- Seating and other mobility devices to enable children to be as mobile and functional as possible
- Orthotics and bracing to maintain proper positioning of a joint