SpringerLink
Log in

Medical Management of Spasticity in Children with Cerebral Palsy

  • Living reference work entry
  • First Online:
Cerebral Palsy

  • 319 Accesses

Abstract

Spasticity is the most common motor disorder in cerebral palsy (CP). It is a component of the upper motor neuron syndrome. Spasticity is probably due to an imbalance between inhibitory and excitatory impulses in the spinal cord. In CP, there is believed to be a deficiency of descending impulses that typically stimulate the release of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). Although some spasticity may be necessary for function in children with neurologic impairment, it is often a problem that can be difficult to treat. Multiple approaches are available for treatment of spasticity in patients with CP including therapies, oral medications, chemodenervation, and intrathecal baclofen therapy. Orthopedic and neurosurgical procedures are also available. A multidisciplinary team should be involved in defining reasonable treatment goals including the patient, and family, physical and occupational therapists, nurses, physiatrist, neurologist, orthopedist, and neurosurgeon.

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

Access this chapter

Log in via an institution

Institutional subscriptions

Similar content being viewed by others

References

  • Abbott R (1996) Selective rhizotomy for treatment of childhood spasticity. J Child Neurol 11:S36–S42

    Article  Google Scholar 

  • Adams MM, Hicks AL (2005) Spasticity after spinal cord injury. Spinal Cord 43:577–586

    Article  CAS  Google Scholar 

  • Albright AL, Barron WB, Fasick MP et al (1993) Continuous intrathecal baclofen infusion for spasticity of cerebral origin. JAMA 270:2475–2477

    Article  CAS  Google Scholar 

  • Albright AL, Barry MJ, Fasick MP et al (1995) Effects of continuous intrathecal baclofen infusion and selective dorsal rhizotomy on upper extremity spasticity. Pediatr Neurosurg 23:82–85

    Article  CAS  Google Scholar 

  • Albright AL, Barry MJ, Fasick MP et al (1996) Continuous intrathecal baclofen for symptomatic generalized dystonia. Neurosurgery 38:934–939

    Article  CAS  Google Scholar 

  • Armstrong RW (1992) Intrathecal baclofen and spasticity: what do we know and what do we need to know. Dev Med Child Neurol 34:739–745

    Article  CAS  Google Scholar 

  • Butler C, Campbell S (2000) Evidence of the effects of intrathecal baclofen for spastic and dystonic cerebral palsy. AACPDM Treatment Outcomes Committee Review Panel. Dev Med Child Neurol 42:634–645

    Article  CAS  Google Scholar 

  • Carr JH, Shepherd R (2001) Neurological rehabilitation: optimizing motor performance. Theoretical consideration in balance assessment. Aust J Physiother 47:89–100

    Article  Google Scholar 

  • Damiano DL, Abel MF (1998) Functional outcomes of strength training in spastic cerebral palsy. Arch Phys Med Rehabil 79:119–125

    Article  CAS  Google Scholar 

  • Damiano DL, Quinlivan JM, Owen BF et al (2002) What does the Ashworth scale really measure and are instrumented measures more valid and precise. Dev Med Child Psychol 44:112–118

    Article  Google Scholar 

  • Elovic EP, Esquenazi A, Alter KE et al (2009) Chemodenervation and nerve blocks in the diagnosis and management of spasticity and muscle overactivity. PMR 1:842–851

    Article  Google Scholar 

  • Gans B, Glenn M (1990) In: Glenn M, Whyte J (eds) The practical management of spasticity in children and adults. Lea & Febiger, Philadelphia, pp 1–7

    Google Scholar 

  • Gerszten PC, Albright AL, Barry MJ (1997) Effect on ambulation of continuous intrathecal baclofen infusion. Pediatr Neurosurg 27:40–44

    Article  CAS  Google Scholar 

  • Gilman S, Newman SW (1987) Manter and Gatz’s essentials of clinical neuroanatomy and neurophysiology. FA Davis Company, Philadelphia, pp 22–28

    Google Scholar 

  • Gormley ME Jr (1999) Management of spasticity in children. Part 2: oral and intrathecal baclofen. J Head Trauma Rehabil 2:207–209

    Article  Google Scholar 

  • Hagglund G, Wagner P (2008) Development of spasticity with age in a total population of children with cerebral palsy. BMC Musculoskelet Disord 9:150

    Article  Google Scholar 

  • Henzel MK, Munin MC, Niyonkuru C et al (2010) Comparison of surface and ultrasound localization to identify forearm flexor muscles for botulinum toxin injections. PMR 2:642–646

    Article  Google Scholar 

  • Katz R (1988) Management of spasticity. Am J Phys Med Rehabil 67:108–116

    Article  CAS  Google Scholar 

  • Katz RT, Campagnolo DI (1994) Pharmacologic management of spasticity. Phys Med Rehabil State Art Rev 8:473–480

    Google Scholar 

  • Keenan C, Alexander M, Sung I et al (2000) Intrathecal baclofen for treatment of spasticity in children. Phys Med Rehabil State Art Rev 12:275–283

    Google Scholar 

  • King MM (2005) Cerebral palsy functional scoring levels, scoring scales. In: Miller F (ed) Cerebral palsy. Springer, New York, pp 834–838

    Google Scholar 

  • Krach LE (2001) Pharmacotherapy of spasticity: oral medications and intrathecal baclofen. J Child Neurol 16:31–36

    Article  CAS  Google Scholar 

  • Krach LE, Gormley ME, Ward M (2015) Traumatic brain injury. In: Alexander MA, Matthews D (eds) Pediatric rehabilitation principles and practice. Demos Medical, New York, pp 429–453

    Google Scholar 

  • Kroin JS, Ali A, York M et al (1993) The distribution of medication along the spinal cord after chronic intrathecal administration. Neurosurgery 33:226–230

    Article  CAS  Google Scholar 

  • Lance JW (1980) Symposium synopsis. In: Young RR, Feldman RG, Koella WP (eds) Spasticity: disordered motor control. Symposia Specialists, Miami, pp 485–495

    Google Scholar 

  • Massagli TL (1991) Spasticity and its management in children. Phys Med Rehabil Clin N Am 2:867–889

    Article  Google Scholar 

  • Mathur SN, Chu SK, McCormick Z et al (2014) Long-term intrathecal baclofen: outcomes after more than 10 years of treatment. PMR 6:506–513

    Article  Google Scholar 

  • McCormick ZL, Chu SH, Binler D et al (2016) Intrathecal versus oral baclofen: a matched cohort study of spasticity, pain, sleep, fatigue, and quality of life. PMR 8:553–562

    Article  Google Scholar 

  • McMahon M, Pruitt D et al (2015) Cerebral palsy. In: Alexander MA, Matthews D (eds) Pediatric rehabilitation principles and practice. Demos Medical, New York, pp 336–364

    Google Scholar 

  • Medtronic ITB Therapy product monograph (2017) Medtronic Inc, Minneapolis

    Google Scholar 

  • Medtronic ITB Therapy technical note (2017) The effects of magnetic resonance imaging (MRI) on SyncroMed II drug infusion systems. Medtronic Inc, Minneapolis

    Google Scholar 

  • Meythaler JM, Guin-Renfroe S, Law C et al (2001) Continuously infused intrathecal baclofen over 12 months for spastic hypertonia in adolescents and adults with cerebral palsy. Arch Phys Med Rehabil 82:155–161

    Article  CAS  Google Scholar 

  • Michaud LJ (2000) Electrical stimulation in children. In: Pediatric rehabilitation state of the art reviews. Physical medical rehabilitation, vol 14, no 2. Hanley and Belfus, Philadelphia, pp 347–362

    Google Scholar 

  • Miller F (1998) Gait analysis in cerebral palsy. In: Dormans JP, Pellegrino L (eds) Caring for the child with cerebral palsy. Brookes, Baltimore, pp 169–191

    Google Scholar 

  • Miller F, Bachrach SJ (2017) Cerebral palsy encyclopedia. In: Cerebral palsy- A complete guide for caregiving. Johns Hopkins University Press, Baltimore, p 442

    Google Scholar 

  • Peacock W, Straudt L (1991) Functional outcomes following selective posterior rhizotomy in children with cerebral palsy. J Neurosurg 74:380–385

    Article  CAS  Google Scholar 

  • Penn R, Savoy SM, Corcos D et al (1989) Intrathecal baclofen for severe spinal spasticity. N Engl J Med 320:1517–1521

    Article  CAS  Google Scholar 

  • Phillips MM, Miljkovic N, Ramos-Lamboy M et al (2015) Clinical experience with continuous intrathecal baclofen trials prior to pump implantation. PMR 7:1052–1058

    Article  Google Scholar 

  • Ried S, Pellegrino L, Albinson-Scull S et al (1998) The management of spasticity. In: Dormans JP, Pellegrino L (eds) Caring for the child with cerebral palsy. Brookes, Baltimore, pp 99–123

    Google Scholar 

  • Rymer WZ, Katz RT (1994) Mechanisms of spastic hypertonia. Phys Med Rehabil State Art Rev 8:441–454

    Google Scholar 

  • Sheean G, McGuire JR (2009) Spastic hypertonia and movement disorders: pathophysiology, clinical presentation and quantification. PMR 1:827–833

    Article  Google Scholar 

  • Simpson DM, Patel AT, Alfaro A et al (2017) OnabotulinumtoxinA injection for poststroke upper-limb spasticity: guidance for the injectors from a delphi panel process. PMR 9:136–148

    Article  Google Scholar 

  • Slominski AH (1984) Winthrop Phelps and the children’s rehabilitation institute. Management of motor disorders of children with cerebral palsy. In: Scrutton D (ed) Management of the motor disorders of children with cerebral palsy. Spastics International Medical Publications, London, pp 59–74

    Google Scholar 

  • Walker HW, Lee MY, Bahroo LB et al (2015) Botulinum toxin injection techniques for the management of adult spasticity. PMR 7:417–427

    Article  Google Scholar 

  • Watanabe TK (2009) Role of oral medications in spasticity management. PMR 1:839–841

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Nemours Alfred I Dupont Hospital for Children, Wilmington, DE, USA

    Maura McManus

Authors
  1. Maura McManus
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maura McManus .

Editor information

Editors and Affiliations

  1. Alfred I. duPont Institute, Wilmington, DE, USA

    Freeman Miller

  2. Cerebral Palsy Program, AI DuPont Hospital for Children , Wilmington, DE, USA

    Steven Bachrach

  3. AI DuPont Hospital for Children , Wilmington, DE, USA

    Nancy Lennon

  4. Drexel University, PHILADELPHIA, PA, USA

    Margaret O'Neil

Section Editor information

  1. Nemours Alfred I. duPont Hospital for Children, Wilmington, DE, USA

    Freeman Miller

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

McManus, M. (2019). Medical Management of Spasticity in Children with Cerebral Palsy. In: Miller, F., Bachrach, S., Lennon, N., O'Neil, M. (eds) Cerebral Palsy. Springer, Cham. https://doi.org/10.1007/978-3-319-50592-3_41-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-50592-3_41-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-50592-3

  • Online ISBN: 978-3-319-50592-3

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation