Advertisement

Spasticity

  • Michael M. McDowell
  • Taylor J. AbelEmail author
Living reference work entry

Abstract

Spasticity in the pediatric population occurs secondary to a complex constellation of associated conditions generating abnormalities in tone that often requires a multidisciplinary management approach. Spasticity, as defined by the Task Force on Childhood Motor Disorders, is a state in which reflexive muscle resistance to an applied force increases in an escalating but not necessarily proportional manner with the velocity of the applied force and/or muscle resistance which dramatically increases once an applied force reaches a specific velocity or point along a given joint’s range of motion (Sanger et al. 2003). It is closely associated in definition and in clinical management with the more general term of hypertonia, the involuntary level of active muscle resistance to passive stretch in exclusion of other factors such as connective tissue and skeletal deformities which may also play a role in decreased joint mobility. Spasticity is independently related to each neuromotor group, and thus movement of a joint in different directions results in different levels of muscular resistance. When poorly controlled, spasticity has the potential to general progressive disability in the form of pain, decreased independence, and the formation of contractures of affected limbs (Albright 1996). In this chapter, we will discuss the etiology, diagnosis, and multidisciplinary management of spasticity.

References

  1. Abbott R, Johann-Murphy M, Shiminski-Maher T, Quartermain D, Forem SL, Gold JT, Epstein FJ (1993) Selective dorsal rhizotomy: outcome and complications in treating spastic cerebral palsy. Neurosurgery 33(5):851–857; discussion 857PubMedGoogle Scholar
  2. Accardo PJ, Capute AJ (2008) Capute & Accardo’s neurodevelopmental disabilities in infancy and childhood, 3rd edn. Paul H. Brookes Pub, BaltimoreGoogle Scholar
  3. Albright AL (1996) Spasticity and movement disorders in cerebral palsy. J Child Neurol 11(Suppl 1):S1–S4.  https://doi.org/10.1177/0883073896011001S01CrossRefPubMedGoogle Scholar
  4. Albright AL, Cervi A, Singletary J (1991) Intrathecal baclofen for spasticity in cerebral palsy. JAMA 265(11):1418–1422CrossRefGoogle Scholar
  5. Albright AL, Barron WB, Fasick MP, Polinko P, Janosky J (1993) Continuous intrathecal baclofen infusion for spasticity of cerebral origin. JAMA 270(20):2475–2477CrossRefGoogle Scholar
  6. Albright AL, Gilmartin R, Swift D, Krach LE, Ivanhoe CB, McLaughlin JF (2003) Long-term intrathecal baclofen therapy for severe spasticity of cerebral origin. J Neurosurg 98(2):291–295.  https://doi.org/10.3171/jns.2003.98.2.0291CrossRefPubMedGoogle Scholar
  7. Arneson CL, Durkin MS, Benedict RE, Kirby RS, Yeargin-Allsopp M, Van Naarden Braun K, Doernberg NS (2009) Prevalence of cerebral palsy: Autism and Developmental Disabilities Monitoring Network, three sites, United States, 2004. Disabil Health J 2(1):45–48.  https://doi.org/10.1016/j.dhjo.2008.08.001CrossRefPubMedGoogle Scholar
  8. Arpino C, Vescio MF, De Luca A, Curatolo P (2010) Efficacy of intensive versus nonintensive physiotherapy in children with cerebral palsy: a meta-analysis. Int J Rehabil Res 33(2):165–171.  https://doi.org/10.1097/MRR.0b013e328332f617CrossRefPubMedGoogle Scholar
  9. Barnett R (2018) Cerebral palsy. Lancet 392(10147):545.  https://doi.org/10.1016/S0140-6736(18)31702-1CrossRefPubMedGoogle Scholar
  10. Bhushan V, Paneth N, Kiely JL (1993) Impact of improved survival of very low birth weight infants on recent secular trends in the prevalence of cerebral palsy. Pediatrics 91(6):1094–1100PubMedGoogle Scholar
  11. Bohannon RW, Smith MB (1987) Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 67(2):206–207CrossRefGoogle Scholar
  12. Boster AL, Adair RL, Gooch JL, Nelson ME, Toomer A, Urquidez J, Saulino M (2016) Best practices for intrathecal baclofen therapy: dosing and long-term management. Neuromodulation 19(6):623–631.  https://doi.org/10.1111/ner.12388CrossRefPubMedGoogle Scholar
  13. Cans C (2000) Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers. Surveillance of Cerebral Palsy in Europe (SCPE). Dev Med Child Neurol 42(12):816–824CrossRefGoogle Scholar
  14. Caulton JM, Ward KA, Alsop CW, Dunn G, Adams JE, Mughal MZ (2004) A randomised controlled trial of standing programme on bone mineral density in non-ambulant children with cerebral palsy. Arch Dis Child 89(2):131–135CrossRefGoogle Scholar
  15. Chan DY, Chan SS, Chan EK, Ng AY, Ying AC, Li AC, … Poon WS (2018) Blessing or burden? Long-term maintenance, complications and clinical outcome of intrathecal baclofen pumps. Surg Pract 22(3):105–110.  https://doi.org/10.1111/1744-1633.12308CrossRefGoogle Scholar
  16. Christensen D, Van Naarden Braun K, Doernberg NS, Maenner MJ, Arneson CL, Durkin MS, … Yeargin-Allsopp M (2014) Prevalence of cerebral palsy, co-occurring autism spectrum disorders, and motor functioning – Autism and Developmental Disabilities Monitoring Network, USA, 2008. Dev Med Child Neurol 56(1):59–65.  https://doi.org/10.1111/dmcn.12268CrossRefGoogle Scholar
  17. D’Aquino D, Moussa AA, Ammar A, Ingale H, Vloeberghs M (2018) Selective dorsal rhizotomy for the treatment of severe spastic cerebral palsy: efficacy and therapeutic durability in GMFCS grade IV and V children. Acta Neurochir 160(4):811–821.  https://doi.org/10.1007/s00701-017-3349-zCrossRefPubMedGoogle Scholar
  18. Deer TR, Prager J, Levy R, Rathmell J, Buchser E, Burton A, … Mekhail N (2012) Polyanalgesic Consensus Conference 2012: recommendations for the management of pain by intrathecal (intraspinal) drug delivery: report of an interdisciplinary expert panel. Neuromodulation 15(5):436–464; discussion 464–436.  https://doi.org/10.1111/j.1525-1403.2012.00476.xCrossRefGoogle Scholar
  19. Deletis V, Vodusek DB, Abbott R, Epstein FJ, Turndorf H (1992) Intraoperative monitoring of the dorsal sacral roots: minimizing the risk of iatrogenic micturition disorders. Neurosurgery 30(1):72–75CrossRefGoogle Scholar
  20. Dudley RW, Parolin M, Gagnon B, Saluja R, Yap R, Montpetit K, … Farmer JP (2013) Long-term functional benefits of selective dorsal rhizotomy for spastic cerebral palsy. J Neurosurg Pediatr 12(2):142–150.  https://doi.org/10.3171/2013.4.PEDS12539PubMedGoogle Scholar
  21. Gigante P, McDowell MM, Bruce SS, Chirelstein G, Chiriboga CA, Dutkowsky J, … Anderson RC (2013) Reduction in upper-extremity tone after lumbar selective dorsal rhizotomy in children with spastic cerebral palsy. J Neurosurg Pediatr 12(6):588–594.  https://doi.org/10.3171/2013.9.PEDS12591
  22. Gilmartin R, Bruce D, Storrs BB, Abbott R, Krach L, Ward J, … Nadell J (2000) Intrathecal baclofen for management of spastic cerebral palsy: multicenter trial. J Child Neurol 15(2):71–77CrossRefGoogle Scholar
  23. Gracies JM (2005) Pathophysiology of spastic paresis. I: paresis and soft tissue changes. Muscle Nerve 31(5):535–551.  https://doi.org/10.1002/mus.20284CrossRefPubMedGoogle Scholar
  24. Gracies JM, Elovic E, McGuire J, Simpson DM (1997) Traditional pharmacological treatments for spasticity. Part I: local treatments. Muscle Nerve Suppl 6:S61–S91CrossRefGoogle Scholar
  25. Grunt S, Becher JG, van Schie P, van Ouwerkerk WJ, Ahmadi M, Vermeulen RJ (2010) Preoperative MRI findings and functional outcome after selective dorsal rhizotomy in children with bilateral spasticity. Childs Nerv Syst 26(2):191–198.  https://doi.org/10.1007/s00381-009-0999-zCrossRefPubMedGoogle Scholar
  26. Hosl M, Bohm H, Eck J, Doderlein L, Arampatzis A (2018) Effects of backward-downhill treadmill training versus manual static plantarflexor stretching on muscle-joint pathology and function in children with spastic cerebral palsy. Gait Posture 65:121–128.  https://doi.org/10.1016/j.gaitpost.2018.07.171CrossRefPubMedGoogle Scholar
  27. James HE, Hofrichter PB, Spierre LZ, Aldana PR (2013) Initiating a pediatric spasticity program with multispecialty and multi-institutional support: a preliminary report. Pediatr Neurosurg 49(1):11–15.  https://doi.org/10.1159/000355125CrossRefPubMedGoogle Scholar
  28. Johnson A (2002) Prevalence and characteristics of children with cerebral palsy in Europe. Dev Med Child Neurol 44(9):633–640CrossRefGoogle Scholar
  29. Kruse M, Michelsen SI, Flachs EM, Bronnum-Hansen H, Madsen M, Uldall P (2009) Lifetime costs of cerebral palsy. Dev Med Child Neurol 51(8):622–628.  https://doi.org/10.1111/j.1469-8749.2008.03190.xCrossRefPubMedGoogle Scholar
  30. Maarrawi J, Mertens P, Luaute J, Vial C, Chardonnet N, Cosson M, Sindou M (2006) Long-term functional results of selective peripheral neurotomy for the treatment of spastic upper limb: prospective study in 31 patients. J Neurosurg 104(2):215–225.  https://doi.org/10.3171/jns.2006.104.2.215CrossRefPubMedGoogle Scholar
  31. Mandigo CE, Anderson RC (2006) Management of childhood spasticity: a neurosurgical perspective. Pediatr Ann 35(5):354–362CrossRefGoogle Scholar
  32. McLachlan EM, Chua M (1983) Rapid adjustment of sarcomere length in tenotomized muscles depends on an intact innervation. Neurosci Lett 35(2):127–133CrossRefGoogle Scholar
  33. McLaughlin J, Bjornson K, Temkin N, Steinbok P, Wright V, Reiner A, … Ferrel A (2002) Selective dorsal rhizotomy: meta-analysis of three randomized controlled trials. Dev Med Child Neurol 44(1):17–25CrossRefGoogle Scholar
  34. Montecucco C, Molgo J (2005) Botulinal neurotoxins: revival of an old killer. Curr Opin Pharmacol 5(3):274–279.  https://doi.org/10.1016/j.coph.2004.12.006CrossRefPubMedGoogle Scholar
  35. Mutlu A, Livanelioglu A, Gunel MK (2008) Reliability of Ashworth and Modified Ashworth scales in children with spastic cerebral palsy. BMC Musculoskelet Disord 9:44.  https://doi.org/10.1186/1471-2474-9-44CrossRefPubMedPubMedCentralGoogle Scholar
  36. Nelson KB, Ellenberg JH (1978) Epidemiology of cerebral palsy. Adv Neurol 19:421–435PubMedGoogle Scholar
  37. Nelson KB, Ellenberg JH (1982) Children who “outgrew” cerebral palsy. Pediatrics 69(5):529–536PubMedGoogle Scholar
  38. Newberg NL, Gooch JL, Walker ML (1991) Intraoperative monitoring in selective dorsal rhizotomy. Pediatr Neurosurg 17(3):124–127.  https://doi.org/10.1159/000120581CrossRefPubMedGoogle Scholar
  39. O’Shea TM (2002) Cerebral palsy in very preterm infants: new epidemiological insights. Ment Retard Dev Disabil Res Rev 8(3):135–145.  https://doi.org/10.1002/mrdd.10032CrossRefPubMedGoogle Scholar
  40. Papavasiliou AS (2009) Management of motor problems in cerebral palsy: a critical update for the clinician. Eur J Paediatr Neurol 13(5):387–396.  https://doi.org/10.1016/j.ejpn.2008.07.009CrossRefPubMedGoogle Scholar
  41. Park EY (2016) Effect of physical therapy frequency on gross motor function in children with cerebral palsy. J Phys Ther Sci 28(6):1888–1891.  https://doi.org/10.1589/jpts.28.1888CrossRefPubMedPubMedCentralGoogle Scholar
  42. Park TS, Liu JL, Edwards C, Walter DM, Dobbs MB (2017) Functional outcomes of childhood selective dorsal rhizotomy 20 to 28 years later. Cureus 9(5):e1256.  https://doi.org/10.7759/cureus.1256CrossRefPubMedPubMedCentralGoogle Scholar
  43. Piatt JH Jr (2015) Pediatric spinal injury in the US: epidemiology and disparities. J Neurosurg Pediatr 16(4):463–471.  https://doi.org/10.3171/2015.2.PEDS1515CrossRefPubMedGoogle Scholar
  44. Pin T, Dyke P, Chan M (2006) The effectiveness of passive stretching in children with cerebral palsy. Dev Med Child Neurol 48(10):855–862.  https://doi.org/10.1017/S0012162206001836CrossRefPubMedGoogle Scholar
  45. Price GW, Wilkin GP, Turnbull MJ, Bowery NG (1984) Are baclofen-sensitive GABAB receptors present on primary afferent terminals of the spinal cord? Nature 307(5946):71–74CrossRefGoogle Scholar
  46. Ravindra VM, Christensen MT, Onwuzulike K, Smith JT, Halvorson K, Brockmeyer DL, … Bollo RJ (2017) Risk factors for progressive neuromuscular scoliosis requiring posterior spinal fusion after selective dorsal rhizotomy. J Neurosurg Pediatr 20(5):456–463.  https://doi.org/10.3171/2017.5.PEDS16630
  47. Reid SM, Dagia CD, Ditchfield MR, Carlin JB, Reddihough DS (2014) Population-based studies of brain imaging patterns in cerebral palsy. Dev Med Child Neurol 56(3):222–232.  https://doi.org/10.1111/dmcn.12228CrossRefPubMedGoogle Scholar
  48. Ronan S, Gold JT (2007) Nonoperative management of spasticity in children. Childs Nerv Syst 23(9):943–956.  https://doi.org/10.1007/s00381-007-0396-4CrossRefPubMedGoogle Scholar
  49. Sanger TD, Delgado MR, Gaebler-Spira D, Hallett M, Mink JW, Task Force on Childhood Motor Disorders (2003) Classification and definition of disorders causing hypertonia in childhood. Pediatrics 111(1):e89–e97CrossRefGoogle Scholar
  50. Sarikcioglu L (2007) Otfrid Foerster (1873–1941): one of the distinguished neuroscientists of his time. J Neurol Neurosurg Psychiatry 78(6):650.  https://doi.org/10.1136/jnnp.2006.112680CrossRefPubMedPubMedCentralGoogle Scholar
  51. Saunders LL, Selassie A, Cao Y, Zebracki K, Vogel LC (2015) Epidemiology of pediatric traumatic spinal cord injury in a population-based cohort, 1998–2012. Top Spinal Cord Inj Rehabil 21(4):325–332.  https://doi.org/10.1310/sci2104-325CrossRefPubMedPubMedCentralGoogle Scholar
  52. Sindou M (1995) Microsurgical DREZotomy (MDT) for pain, spasticity, and hyperactive bladder: a 20-year experience. Acta Neurochir 137(1–2):1–5CrossRefGoogle Scholar
  53. Smania N, Bonetti P, Gandolfi M, Cosentino A, Waldner A, Hesse S, … Munari D (2011) Improved gait after repetitive locomotor training in children with cerebral palsy. Am J Phys Med Rehabil 90(2):137–149.  https://doi.org/10.1097/PHM.0b013e318201741eCrossRefGoogle Scholar
  54. Spader HS, Bollo RJ, Bowers CA, Riva-Cambrin J (2016) Risk factors for baclofen pump infection in children: a multivariate analysis. J Neurosurg Pediatr 17(6):756–762.  https://doi.org/10.3171/2015.11.PEDS15421CrossRefPubMedGoogle Scholar
  55. Steinbok P (2006) Selection of treatment modalities in children with spastic cerebral palsy. Neurosurg Focus 21(2):e4PubMedGoogle Scholar
  56. Strobl W, Theologis T, Brunner R, Kocer S, Viehweger E, Pascual-Pascual I, Placzek R (2015) Best clinical practice in botulinum toxin treatment for children with cerebral palsy. Toxins (Basel) 7(5):1629–1648.  https://doi.org/10.3390/toxins7051629CrossRefGoogle Scholar
  57. Thilmann AF, Fellows SJ, Garms E (1991) The mechanism of spastic muscle hypertonus. Variation in reflex gain over the time course of spasticity. Brain 114(Pt 1A):233–244PubMedGoogle Scholar
  58. Tonmukayakul U, Shih STF, Bourke-Taylor H, Imms C, Reddihough D, Cox L, Carter R (2018) Systematic review of the economic impact of cerebral palsy. Res Dev Disabil 80:93–101.  https://doi.org/10.1016/j.ridd.2018.06.012CrossRefPubMedGoogle Scholar
  59. Trompetto C, Marinelli L, Mori L, Pelosin E, Curra A, Molfetta L, Abbruzzese G (2014) Pathophysiology of spasticity: implications for neurorehabilitation. Biomed Res Int 2014:354906.  https://doi.org/10.1155/2014/354906CrossRefPubMedPubMedCentralGoogle Scholar
  60. Turner RP (2009) Neurophysiologic intraoperative monitoring during selective dorsal rhizotomy. J Clin Neurophysiol 26(2):82–84.  https://doi.org/10.1097/WNP.0b013e31819f9077CrossRefPubMedGoogle Scholar
  61. Vadivelu S, Stratton A, Pierce W (2015) Pediatric tone management. Phys Med Rehabil Clin N Am 26(1):69–78.  https://doi.org/10.1016/j.pmr.2014.09.008CrossRefPubMedGoogle Scholar
  62. Vitale MG, Goss JM, Matsumoto H, Roye DP Jr (2006) Epidemiology of pediatric spinal cord injury in the United States: years 1997 and 2000. J Pediatr Orthop 26(6):745–749.  https://doi.org/10.1097/01.bpo.0000235400.49536.83CrossRefPubMedGoogle Scholar
  63. Wright FV, Sheil EM, Drake JM, Wedge JH, Naumann S (1998) Evaluation of selective dorsal rhizotomy for the reduction of spasticity in cerebral palsy: a randomized controlled tria. Dev Med Child Neurol 40(4):239–247CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of Pediatric Neurological SurgeryChildren’s Hospital of PittsburghPittsburghUSA
  2. 2.Department of Neurological SurgeryUniversity of Pittsburgh Medical CenterPittsburghUSA

Section editors and affiliations

  • James T. Rutka
    • 1
    • 2
  1. 1.Division of Neurosurgery, Suite 1503The Hospital for Sick ChildrenTorontoCanada
  2. 2.The Arthur and Sonia Labatt Brain Tumour Research CentreThe Hospital for Sick ChildrenTorontoCanada

Personalised recommendations