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38% of stroke survivors experience post-stroke spasticity within one year after a first stroke.

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The treatment of adult with spasticity should be provided by a multidisciplinary team employing a shared-care approach. A variety of treatment options is available and clinical experience has shown that a multi-modal approach has many benefits.  In most cases, a combination of various types of treatment is required to achieve the specific goals of treatment for a particular patient.

A rehabilitation plan must be tailored to individual patient needs, and is likely to involve medical intervention (e.g., botulinum toxin, pain medication), as well as multiple additional therapies – for example physical, occupational and psychological approaches. Together, these therapies enable optimal management of functional problems such as impaired mobility, strength, balance, and endurance, amongst other spasticity-related issues.

The primary aim of treatment is to facilitate life for people with spasticity and for their caregivers, thus improving their quality of life. Therefore, improvement in function is a key long-term factor in spasticity management. Consequently, the development of realistic and clinically relevant goals for each individual patient is the key for a successful treatment. These goals should  be defined  and  followed  up in collaboration with other members  of the  spasticity management team that  may include a specialist for physical medicine and rehabilitation, a neurologist, a physiatrist, a physiotherapist, an occupational therapist, a neurosurgeon, and an orthotist  (specialist concerned with the design,  manufacture and application  of orthoses).

The importance of adapting the treatment to patients’ symptoms and especially to patients’ needs throughout the course of treatment is crucial, with expectations revisited and redefined if necessary at regular intervals.

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38% of stroke survivors experience post-stroke spasticity within one year after a first stroke, while the overall prevalence of post-stroke spasticity is approximately 0.2% (taken from the WHO MONICA project)

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Botulinum toxin type A (BoNT/A) is recommended as a first-line therapy in national and international guidelines as part of an integrated treatment approach for post-stroke spasticity.

Botulinum toxin creates a ‘window of opportunity’ for improving motor and activity performance3 and should always be followed by physical therapy.

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Physical therapy is the mainstay of treatment for spasticity, and is designed to reduce muscle tone, maintain or improve range of motion and mobility, increase strength and coordination, and improve care and comfort.

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When not controllable by physical therapy, oral or intrathecal medications and/or botulinum toxin injections, spasticity symptoms can be treated with selective ablative procedures. In most cases, complementary neurosurgical and functional orthopedic approaches are used.

With surgical interventions, muscles can be denervated or tendons and muscles can be released, lengthened, or transferred to relieve the symptoms of spasticity. In practice, only 5% of spasticity patients undergo a surgical intervention.

By orthopedic surgery, muscles can be denervated, and tendons and muscles can be released, lengthened, or transferred. In order to release contractures, the contracted tendon is partially or completely split surgically and then the joint is repositioned at a more normal angle.  A cast stabilizes the joint over a period of several weeks while the tendon regrows.  After removing the cast, physical therapy is necessary to strengthen the muscles and improve the patient’s range of motion.

Surgical intervention that is used for the treatment of spasticity is called functional or selective dorsal rhizotomy (SDR). In this procedure, the neurosurgeon  cuts nerve roots (rhizotomy) – the nerve fibers lying just outside  the back bone  (spinal column) that  send sensory messages from the muscles to the spinal cord. ‘Selective’  indicates that  only certain  nerve roots are cut, and ‘dorsal’ refers to the target  nerves that  are located  at the back of the spinal cord (the upper  surface  when  a person  is lying on his or her stomach).