Spasticity

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.