Spasticity Management

 Patient with TBI present with abnormalities of muscle tone. Mostly manifested as increased tone, hypertonia or spasticity.

Stretching and strengthening exercise with adjuctive modalities and functional retraining.

PROM and selective strengthening of antagonist muscles.

Proper positioning, maintaining head and neck in neutral position to minimize the effect of primitive reflexes.

Splints and serial casting can also assist in decreasing hypertonicity. These devices maintain a constant stretch and thereby increase the ROM and decrease tone. Serial casting prevents biceps and planter flexion contractures. Positioning splints will temporarily decrease tone, wrist and hand splints are effective. They prevent prolong shortening of muscles.

Neurostimulation can cause inhibition of abnormally high tone. The stimulation can be applied either to agonist/antagonist weight wearing on the affected limb, rhythmic rotation and aquatic therapy.

Botox and Phenol nerve blockers are synergistic anti-spasticity intervention. Botox paralyses the muscles to which it is administrated and prevents pre-synaptic nerve from releasing acetylcholine into the synaptic cleft such that hyperactive CNS cannot effect muscle contraction.

Phenol demyelinates nerves in lower concentration and denatures axonal protein at higher concentration.

Botox can best be administrated in highly innervated site such as intrinsic muscle of hand, paraspinals, pectoralis major, etc.

Medications prescribed to treat spasticity includes baclofen, tizanidine, clonidine, diazepam and dantrolene. 

Surgical interventions include orthopaedic tenotomies as well as neurological ablative non-destructive procedures. Rhizotomy also performed to treat severe spasticity by baclofen pump implantation in the abdominal wall.