Spasticity Assessment and Management

Publication Date: May 22, 2024
Last Updated: May 30, 2024

Best Practices for Spasticity Assessment and Management

  • A-1: As a component of the initial patient evaluation, clinicians should assess the impact of spasticity on passive and active movement, ability to repeat movements, and function to guide its treatment/management.
  • A-2: Reassessment of spasticity should occur throughout the treatment course. Specifically, reassessment should occur before or at the time of each treatment to consider whether to continue the same treatment or to change the course of treatment.
  • A-3: Standardized measures to evaluate spasticity should be utilized at each evaluation to optimize consistency and to objectively measure response when an intervention is applied.
  • A-4: Treating spasticity should start with optimizing medical management. Physiatrists should make sure that patients are medically stable and address any medical problems that may exacerbate spasticity.
  • A-5: To assess the extent to which a patient's goals are being met, a goal attainment scale or other means of measuring treatment response may be considered in each reassessment.

Clinical Recommendations for Spasticity Management

Pharm-1

The AAPM&R Spasticity TEP suggests use of oral medications to manage generalized or systemic spasticity; oral medications can be used either exclusively or as a component of a multimodal treatment approach. (C)
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INJ-1

The AAPM&R Spasticity TEP recommends clinicians consider use of botulinum toxin A for management of focal upper and lower limb spasticity. (A)
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INJ-2

The AAPM&R Spasticity TEP suggests that clinicians consider use of phenol or alcohol blocks for management of focal spasticity. (C)
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SUR-1

The AAPM&R Spasticity TEP recommends use of intrathecal baclofen pump therapy (ITB) as an effective treatment of spinal or cerebral origin spasticity in appropriately identified patients. (A)
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SUR-2

The AAPM&R TEP recommends utilization of selective dorsal rhizotomy (SDR) to treat spasticity with proper patient selection focused on patients with primarily spasticity of the lower extremity (LE), adequate LE strength and selective motor control, and absence of significant contractures. (A)
Technical Note: Historically, the procedure has primarily been performed in children; more recently SDR in adults has been noted to be helpful in reducing spasticity, maintaining or improving level of ambulation, but with a higher propensity to develop new sensory deficits or neuropathic pain.
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NP-1

The AAPM&R Spasticity TEP recommends consideration of use of nonpharmacologic interventions from a range of treatment modalities, in conjunction with other therapeutic options to effect spasticity and facilitate the effects of pharmacologic and procedural interventions on spasticity and to improve function and decrease deleterious effects of contributing conditions. (N)
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Recommendation Grading

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Overview

Title

Spasticity Assessment and Management

Authoring Organization

American Academy of Physical Medicine and Rehabilitation

Publication Month/Year

May 22, 2024

Last Updated Month/Year

May 30, 2024

Document Type

Consensus

Country of Publication

US

Document Objectives

To develop consensus-based practice recommendations to identify and address gaps in spasticity care. This consensus guidance provides clinicians with practical recommendations for spasticity assessment and management based on the best available evidence and expert opinion. Clinical judgment should be exercised, and recommendations tailored to individual patient needs, preferences, and risk profiles. The accompanying table summarizes the best practice recommendations for spasticity assessment and management, reflecting principles with little controversy in care delivery.

Health Care Settings

Ambulatory, Long term care

Intended Users

Nurse, nurse practitioner, physical therapist, physician, physician assistant

Scope

Management

Diseases/Conditions (MeSH)

D009128 - Muscle Spasticity

Keywords

adult spasticity, spasticity

Source Citation

Verduzco-Gutierrez M, Raghavan P, Pruente J, Moon D, List CM, Hornyak JE, Gul F, Deshpande S, Biffl S, Al Lawati Z, Alfaro A. AAPM&R consensus guidance on spasticity assessment and management. PM R. 2024 May 21. doi: 10.1002/pmrj.13211. Epub ahead of print. PMID: 38770827.