Spasticity
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Spasticity
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Authors: Margaret Means, MDSonika Agarwal, MBBS, MD  
Children’s Hospital of Philadelphia 

Reviewed: September 2021 

SUMMARY

Spasticity is a term used to describe a muscle and joint condition in children. In this condition, a child’s joints are more difficult to move and bend due to tightness in the muscles. Examples of affected joints are knees, elbows, and ankles. 

Spasticity can have many different causes. They are usually related to a spinal cord or brain problem.  

Spasticity can be diagnosed by a physical exam. Usually, specialists make the diagnosis. The specialists might be: 

  • Pediatric neurologists: These are children’s brain doctors. 
  • Rehabilitation or therapy specialists: Therapies may include physical therapy, speech therapy, occupational therapies, and other types. These specialists treat issues related to muscle tone, movements, or postures.  

After diagnosis, a doctor may order imaging studies of the brain or spinal cord to look for a cause. Depending on the cause, children may have other signs and symptoms in addition to spasticity. 

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Disorder Overview

DESCRIPTION 

Any number of different issues in the brain or spinal cord can cause spasticity. This is because our muscles are controlled by nerves. Nerves connect muscles to the spinal cord and brain. A problem at any point along a nerve pathway can lead to spasticity. Spasticity is a sign of an underlying problem in the nervous system. 

Children with spasticity may have: 

  • Arms or legs that are difficult to move due to muscle tightness 
  • More muscle resistance to stretching and movement 

SIGNS AND SYMPTOMS

Signs 

There are several signs of spasticity: 

Resistance

The primary sign is an increased resistance to movement at a joint.

Reflexes

Another sign is exaggerated tendon reflexes. 

Range

A third sign is a restricted range of movement at a joint. This occurs especially if spasticity is not treated. It is due to something called contractures.  

 

Spasticity can appear: 

  • Shortly after birth 
  • Later in life, if a child has an injury to the nervous system  

Symptoms 

Possible symptoms include: 

  • Muscle stiffness 
  • Pain 
  • Muscle spasms 
  • Clonus, or repeated muscle contractions 
  • Scissoring (involuntary crossing) of the legs 
  • Contractures, or fixed joints that cannot be moved 
  • Difficulty moving the affected limbs 
  • Difficulty walking 
  • Changes in sensation 

child may have other symptoms, too, depending on the underlying cause of the spasticity.

For example: 

Stroke as underlying cause

Some children have spasticity resulting from stroke that occurred prior to birth. Depending on where the stroke was in the brain, it may cause spasticity as well as other symptoms. For instance, it may cause developmental delays or muscle weakness on one side of the body. It may cause learning difficulties.  

Injury to spinal cord as underlying cause

If the spasticity is a result of an injury in the spinal cord, the child may have problems with bowel or bladder control. They may experience weakness of some muscles. 

CAUSES

There are many different possible causes of spasticity. It can be caused by anything that damages the nerves in the brain or spinal cord. Spasticity develops after a certain period of time following the damage.

Some examples of causes include:

  • Premature birth  
  • Strokes 
  • Infections 
  • Genetic conditions 
  • Tumors 
  • Metabolic diseases 
  • Toxins  
  • Trauma  

INVESTIGATIONS 

Clinical Exams 

A diagnosis involves examining the child’s joints and muscles. A child with suspected spasticity will be referred to a child neurologist and a rehabilitation specialist. 

The neurologist will: 

  • Take a complete health history, including family history, birth history, and medical/surgical history 
  • Perform a physical exam 
  • Recommend any further testing needed: neuroimaging, laboratory studies, genetic studies, etc. 
  • Refer to other specialists as necessary 

The rehabilitation specialist will: 

  • Perform an exam: assess tone, range of movement, posture and recommend therapies 
  • Recommend medications for tone management 

Imaging Studies 

Doctors may order pictures of the brain and spinal cord. The pictures can show if there has been damage to these areas, causing the spasticity. The most likely type of imaging they order is magnetic resonance imaging (MRI).    

 Blood tests 

Depending on your child’s health history and their other symptoms, the doctor may order blood tests to look for possible causes. They may ask for tests to look for: 

  • Infection 
  • Metabolic abnormalities 
  • Genetic abnormalities 

TREATMENT AND THERAPIES  

A team of therapists work with children with spasticity. They can help make progress with:

  • Developmental milestones
  • Strength
  • Muscle tone
  • Range of motion

Possible treatments include:

Medications

These can help relax muscles that are too tight. Examples include baclofen, diazepam, tizanidine. 

Physical therapy and stretching

Splinting, casting, or bracing

This can help with range of motion and flexibility.

Occupational therapy

Speech therapy

Botox injections

Botox injection into tendons that are very tight can help them relax.

Surgery

Surgery on very tight tendons can help relieve tension. 

Assistive devices and equipment

This can help with activities of daily living. They are recommended based on the support a child needs. 

 

OUTLOOK

Spasticity may get progressively worse, stay the same, or get better with therapies and treatment. This will depend on its cause. 

Some children with mild spasticity do not have any issues with normal function. Others with more severe spasticity may not be able to walk on their own. They may not be able to perform daily tasks without help. Usually, the more severely affected the brain or spinal cord is by the underlying cause, the more severe the symptoms of spasticity. 

Resources

ORGANIZATIONS/GROUPS 

Cerebral Palsy Research Network 
The mission of the Cerebral Palsy Research Network (CP Research Network) is to optimize the lifelong health and wellness of people with cerebral palsy and their families through high quality research, education, and community programming. The CP Research Network is the largest and most comprehensive collaboration of hospitals and community members working together to improve health outcomes for people with CP. Through a search for Spasticity on their website, you will find articles, videos, and research studies. 

Spastic Paraplegia Foundation 
The Spastic Paraplegia Foundation, Inc. (SPF) is the only organization in the Americas dedicated to finding a cure for Hereditary Spastic Paraplegia (HSP) and Primary Lateral Sclerosis (PLS). They are a not-for-profit voluntary organization. The primary goal has been to raise money to find a cure. Since their creation in 2002, they have raised and funded over $10 million in research grants. SPF hosts a private Facebook group, Spastic Paraplegia Foundation, Inc #HSPandPLS 

PUBLICATIONS 

The Cerebral Palsy Tool Kit
Cerebral Palsy Research Network offers The Cerebral Palsy Tool Kit: From Diagnosis to Understanding for parents and caregivers who have a child with a Cerebral Palsy diagnosis. This must-have guide is available in English, Portuguese, and Spanish and available to download for free. You may also purchase a printed copy.

Wellbeing for Parents and Caregivers 
Cerebral Palsy Research Network offers Wellbeing for Parents and Caregivers, a supportive resource guide for parents and caregivers who are raising a child, adolescent or young adult with Cerebral Palsy or another disability. Available to download for free.

Child Neurology Foundation (CNF) solicits resources from the community to be included on this webpage through an application process. CNF reserves the right to remove entities at any time if information is deemed inappropriate or inconsistent with the mission, vision, and values of CNF. 

Research 

ClinicalTrials.gov for Spasticity are clinical trials that are recruiting or will be recruiting. Updates are made daily, so you are encouraged to check back frequently.  

ClinicalTrials.gov is a database of privately and publicly funded clinical studies conducted around the world. This is a resource provided by the U.S. National Library of Medicine (NLM), which is an institute within the National Institutes of Health (NIH). Listing a study does not mean it has been evaluated by the U.S. Federal Government. Please read the NLM disclaimer for details.  

Before participating in a study, you are encouraged to talk to your health care provider and learn about the risks and potential benefits. 

The information in the CNF Child Neurology Disorder Directory is not intended to provide diagnosis, treatment, or medical advice and should not be considered a substitute for advice from a healthcare professional. Content provided is for informational purposes only.  CNF is not responsible for actions taken based on the information included on this webpage. Please consult with a physician or other healthcare professional regarding any medical or health related diagnosis or treatment options. 

References

Spasticity Information PageNational Institute of Neurological Disorders and Stroke. Updated March 27, 2019. https://www.ninds.nih.gov/Disorders/All-Disorders/Spasticity-Information-Page 

Spasticity. The Cleveland Clinic. Published January 28, 2019. https://my.clevelandclinic.org/health/diseases/14346-spasticity  

Swaiman KF. Swaiman’s pediatric neurology: Principles and practice. Edinburgh: Elsevier; 2018. Ch 5: Muscular tone and gait disturbances. p. 2731. https://www.worldcat.org/title/swaimans-pediatric-neurology-principles-and-practice/oclc/993643240  

Pina-Garza JE. Fenichel’s clinical pediatric neurology. London: Elsevier Saunders; 2013. Ch 12Paraplegia and quadriplegia. p. 253-269. https://www.worldcat.org/title/fenichels-clinical-pediatric-neurology/oclc/1036254009  

Thank you to our 2022 Disorder Directory partner Jazz Pharmaceuticals. And to our 2021 partners Acadia, Aeglea, Amicus Therapeutics, bluebird bio, Eisai, Greenwich Biosciences (now Jazz Pharmaceuticals), Liva Nova, Origin, Ovid, PTC Therapeutics and UCB for their support of the Disorder Directory.

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