Skip to main content
SpringerLink
Log in

Management of Spasticity

  • Chapter
Management of Post-Stroke Complications

Abstract

Spasticity is one of the many components of the upper motor neurone syndrome; the other components including exaggerated reflexes, clonus, clasp-knife phenomena, flexor and extensor spasms, spastic dystonia, and Babinski’s sign. Spasticity is a symptom that is not isolated and can cause pain, stiffness, and spasm, resulting in a massive impact on a person’s physical and emotional lifestyle. The management of spasticity requires a multidisciplinary approach incorporating nurses, physicians, physiotherapists, occupational therapists, and orthotists working together to provide a variety of treatments tailored to the needs of the individual patient.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Lance JW. Symposium synopsis. In: Feldman RG, Young RR, Koella WP, editors. Spasticity: disordered motor control. Chicago: Yearbook Medical; 1980. p. 485–94.

    Google Scholar 

  2. Lundstrom E, Terent A, Borg J. Prevalence of disabling spasticity 1 year after first-ever stroke. Eur J Neurol. 2008;15:533–9.

    Article  CAS  PubMed  Google Scholar 

  3. Watkins CL, Leathley MJ, Gregson JM, Moore AP, Smith TL, Sharma AK. Prevalence of spasticity post stroke. Clin Rehabil. 2002;16:515–22.

    Article  CAS  PubMed  Google Scholar 

  4. Ward AB. A literature review of the pathophysiology and onset of post-stroke spasticity. Eur J Neurol. 2012;19:21–7.

    Article  PubMed  Google Scholar 

  5. Wissel J, Ludwig D, Schelosky SJ, Christe W, Faiss JH, Mueller J. Early development of spasticity following stroke: a prospective, observational trial. J Neurol. 2010;257:1067–72.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Hefter H, Jost WH, Reissig A, Zakine B, Bakheit AM, Wissel J. Classification of posture in poststroke upper limb spasticity: a potential decision tool for botulinum toxin A treatment? Int J Rehabil Res. 2012;35:227–33.

    PubMed  Google Scholar 

  7. Marciniak C. Poststroke hypertonicity: upper limb assessment and treatment. Top Stroke Rehabil. 2011;18:179–94.

    Article  PubMed  Google Scholar 

  8. Priori A, Cogiamanian F, Mrakic-Sposta S. Pathophysiology of spasticity. Neurol Sci. 2006;27:S307–9.

    Article  Google Scholar 

  9. Sheean G. The pathophysiology of spasticity. Eur J Neurol. 2002;9 Suppl 1:3–9.

    Article  PubMed  Google Scholar 

  10. Currie R. Spasticity: a common symptom of multiple sclerosis. Nurs Stand. 2001;15:47–52.

    Article  CAS  PubMed  Google Scholar 

  11. Royal College of Physicians. Spasticity in adults: Management using botulinum toxin. National Guidelines. 2009.

    Google Scholar 

  12. Jarrett L. The nurse’s role in assessing and measuring spasticity. Nurs Times. 2006;102:26–8.

    PubMed  Google Scholar 

  13. Atiyeh BS, Hayek SN. Pressure sores with associated spasticity: a clinical challenge. Int Wound J. 2005;2:77–80.

    Article  PubMed  Google Scholar 

  14. Gibson J, Frank A. Supporting individuals with disabling multiple sclerosis. J R Soc Med. 2002;95:580–6.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Ashworth B. Preliminary trial of carosprodol in multiple sclerosis. Practitioner. 1964;192:540–2.

    CAS  PubMed  Google Scholar 

  16. Boyd RN, Graham HK. Objective measurement of clinical findings in the use of botulinum toxin type A for the management of children with cerebral palsy. Eur J Neurol. 1999;6 Suppl 4:S23–35.

    Article  Google Scholar 

  17. Gregson JM, Leathley MJ, Moore AP, Smith TL, Sharma AK, Watkins CL. Reliability of measurements of muscle tone and muscle power in stroke patients. Age Ageing. 2000;29:223–8.

    Article  CAS  PubMed  Google Scholar 

  18. Biering-Sorensen F, Nielsen JB, Klinge K. Spasticity-assessment: a review. Spinal Cord. 2006;44:708–22.

    Article  CAS  PubMed  Google Scholar 

  19. Ben-Shabat E, Palit M, Fini NA, Brooks CT, Winter A, Holland AE. Intra- and inter-rater reliability of the Modified Tardieu Scale for the assessment of lower limb spasticity in adults with neurologic injuries. Arch Phys Med Rehabil. 2013;94:2494–501.

    Article  PubMed  Google Scholar 

  20. Mehrholz J, Major Y, Meissner D, Sandi-Gahun S. The influence of contractures and variation in measurement stretching velocity on the reliability of the Modified Ashworth Scale in patients with severe brain injury. Clin Rehabil. 2005;19:63–72.

    Article  PubMed  Google Scholar 

  21. Thompson AJ, Jarrett L, Lockley L, Marsden J, Stevenson VL. Clinical management of spasticity. J Neurol Neurosurg Psychiatry. 2005;76:459–63.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  22. Marrie RA, Goldman M. Validity of performance scales for disability assessment in multiple sclerosis. Mult Scler. 2007;13:1176–82.

    Article  CAS  PubMed  Google Scholar 

  23. Turner-Stokes L, Rusconi S. AbilityQ and ShoulderQ: a system to assess shoulder pain in stroke patients. Clin Rehabil. 2002;17:150–7.

    Article  Google Scholar 

  24. Kiresuk TJ, Sherman RE. Goal attainment scaling: a general method for evaluating comprehensive community mental health programs. Community Ment Health J. 1968;4:443–53.

    Article  CAS  PubMed  Google Scholar 

  25. Ashford S, Turner-Stokes L. Goal attainment for spasticity management using botulinum toxin. Physiother Res Int. 2006;11:24–34.

    Article  PubMed  Google Scholar 

  26. Wang RY, Chen HI, Chen CY, Yang YR. Efficacy of Bobath versus orthopaedic approach on impairment and function at different motor recovery stages after stroke: a randomized controlled study. Clin Rehabil. 2005;19:155–64.

    Article  PubMed  Google Scholar 

  27. Boman K. Effect of emotional stress on spasticity and rigidity. J Psychosom Res. 1971;15:107–12.

    Article  CAS  PubMed  Google Scholar 

  28. Kita M, Goodkin DE. Drugs used to treat spasticity. Drugs. 2000;59:487–95.

    Article  CAS  PubMed  Google Scholar 

  29. Pathak MS, Nguyen HT, Graham HK, Moore AP. Management of spasticity in adults: practical application of botulinum toxin. Eur J Neurol. 2006;13 Suppl 1:42–50.

    Article  PubMed  Google Scholar 

  30. Richardson D. Physical therapy in spasticity. Eur J Neurol. 2002;9 Suppl 1:17–22.

    Article  PubMed  Google Scholar 

  31. Lewis M, Rushanan S. The role of physical therapy and occupational therapy in the treatment of amyotrophic lateral sclerosis. Neuro Rehabil. 2007;22:451–61.

    Google Scholar 

  32. Bolin I, Bodin P, Kreuter M. Sitting position – posture and performance in C5–C6 tetraplegia. Spinal Cord. 2000;38:425–34.

    Article  CAS  PubMed  Google Scholar 

  33. Pizzi A, Carlucci G, Falsini C, Verdesca S, Grippo A. Application of a volar static splint in post-stroke spasticity of the upper limb. Arch Phys Med Rehabil. 2005;86:1855–9.

    Article  PubMed  Google Scholar 

  34. Ward B. A summary of spasticity management – a treatment algorithm. Eur J Neurol. 2002;9 Suppl 1:48–52.

    Article  PubMed  Google Scholar 

  35. Abbruzzese G. The medical management of spasticity. Eur J Neurol. 2002;9 Suppl 1:30–4.

    Article  PubMed  Google Scholar 

  36. Gallichio JE. Pharmacologic management of spasticity following stroke. Phys Ther. 2004;84:973–81.

    PubMed  Google Scholar 

  37. Kamen L, Henney 3rd HR, Runyan JD. A practical overview of Tizanidine use for spasticity secondary to multiple sclerosis, stroke, and spinal cord injury. Curr Med Res Opin. 2008;24:425–39.

    Article  CAS  PubMed  Google Scholar 

  38. Groves L, Shellenberger MK, Davis CS. Tizanidine treatment of spasticity: a meta-analysis of controlled, double-blind, comparative studies with baclofen and diazepam. Adv Ther. 1998;9:241–51.

    Google Scholar 

  39. Miettinen TJ, Kanto JH, Salonen MA, Scheinin M. The sedative and sympatholytic effects of oral Tizanidine in healthy volunteers. Anesth Analg. 1996;82:817–20.

    CAS  PubMed  Google Scholar 

  40. Gelber DA, Good DC, Dromerick A, Sergay S, Richardson M. Open-label dose-titration safety and efficacy study of Tizanidine hydrochloride in the treatment of spasticity associated with chronic stroke. Stroke. 2001;32:1841–6.

    Article  CAS  PubMed  Google Scholar 

  41. DeJak JJ, Lowry R. Use of diazepam (valium) for spasticity in spinal cord injury. Proc Annu Clin Spinal Cord Inj Conf. 1964;13:78–81.

    CAS  PubMed  Google Scholar 

  42. Pinder RM, Brogden RN, Speight TM, Avery GS. Dantrolene sodium: a review of its pharmacological properties and therapeutic efficacy in spasticity. Drugs. 1977;9:3–23.

    Article  Google Scholar 

  43. Ward A, Chaffman MO, Sorkin EM. Dantrolene. A review of its pharmacodynamic and pharmacokinetic properties and therapeutic use in malignant hyperthermia, the neuroleptic malignant syndrome and an update of its use in muscle spasticity. Drugs. 1986;32:130–68.

    Article  CAS  PubMed  Google Scholar 

  44. Formica A, Verger K, Sol JM, Morralla C. Gabapentin for spasticity: a randomized, double blind, placebo- controlled trial. Med Clin (Barc). 2005;124:81–5.

    Article  PubMed  Google Scholar 

  45. Saulino M, Jacobs BW. The pharmacological management of spasticity. J Neurosci Nurs. 2006;38:456–9.

    PubMed  Google Scholar 

  46. Shaw LC, Price CI, van Wijck FM, Shackley P, Steen N, Barnes MP, et al. Botulinum Toxin for the Upper Limb after Stroke (BoTULS) Trial: effect on impairment, activity limitation, and pain. Stroke. 2011;42:1371–9.

    Article  CAS  PubMed  Google Scholar 

  47. Davis EC, Barnes MP. Botulinum toxin and spasticity. J Neurol Neurosurg Psychiatry. 2000;69:143–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  48. Johnson CA, Burridge JH, Strike PW, Wood DE, Swain ID. The effect of combined use of botulinum toxin type A and functional electric stimulation in the treatment of spastic drop foot after stroke: a preliminary investigation. Arch Phys Med Rehabil. 2004;85:902–9.

    Article  PubMed  Google Scholar 

  49. Hesse S, Reiter F, Konrad M, Jahnke MT. Botulinum toxin type A and short-term electrical stimulation in the treatment of upper limb flexor spasticity after stroke: a randomized, double-blind, placebo-controlled trial. Clin Rehabil. 1998;12:381–8.

    Article  CAS  PubMed  Google Scholar 

  50. Viel E, Pelissier J, Pellas F, Boulay C, Eledjam JJ. Alcohol neurolytic blocks for pain and muscle spasticity. Neurochirurgie. 2003;49:256–62.

    CAS  PubMed  Google Scholar 

  51. Beckerman H, Lankhorst GJ, Verbeek ALM, Becher J. The effects of phenol nerve and muscle blocks in treating spasticity: review of the literature. Crit Rev Phys Rehab Med. 1996;8(Issue 1–2):111–24.

    Article  Google Scholar 

  52. Gaid M. Phenol nerve block for management of lower limb spasticity. Rehabilitation articles. Advances in Clinical Neuroscience and Rehabilitation. 2012;12:23–5.

    Google Scholar 

  53. Meythaler JM, Guin-Renfroe S, Brunner RC, Hadley MN. Intrathecal baclofen for spastic hypertonia from stroke. Stroke. 2001;32:2099–109.

    Article  CAS  PubMed  Google Scholar 

  54. Lazorthes Y, Sol JC, Sallerin B, Verdié JC. The surgical management of spasticity. Eur J Neurol. 2002;9 Suppl 1:35–41.

    Article  PubMed  Google Scholar 

  55. Bollens B, Gustin T, Stoquart G, Detrembleur C, Lejeune T, Deltombe T. A randomized controlled trial of selective neurotomy versus botulinum toxin for spastic equinovarus foot after stroke. Neurorehabil Neural Repair. 2013;27:695–703.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Ageing and Health, Guy’s and St Thomas’ NHS Foundation Trust, London, UK

    Jonathan Birns PhD, FRCP

  2. Department of Clinical Transformation, Geriatrics and General Medicine, Croydon University Hospital, London, UK

    Tehmina S. Irani MB, BS, MRCP, SCE in Geriatrics

Authors
  1. Jonathan Birns PhD, FRCP
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tehmina S. Irani MB, BS, MRCP, SCE in Geriatrics
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jonathan Birns PhD, FRCP .

Editor information

Editors and Affiliations

  1. Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom

    Ajay Bhalla

  2. Department of Ageing & Health, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom

    Jonathan Birns

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Birns, J., Irani, T.S. (2015). Management of Spasticity. In: Bhalla, A., Birns, J. (eds) Management of Post-Stroke Complications. Springer, Cham. https://doi.org/10.1007/978-3-319-17855-4_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-17855-4_10

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-17854-7

  • Online ISBN: 978-3-319-17855-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation