Spasticity: linking treatment to a specific daily task

With spasticity, start with what is causing difficulty: opening a hand for hygiene is painful, an orthosis is hard to put on, night spasms disturb sleep or transfers are awkward. A muscle feeling less stiff does not by itself establish that treatment helped. A useful goal connects a change in muscle activity to a particular task or the patient’s comfort.

Less stiffness does not always mean better function

Spasticity follows disruption of the nervous system’s control of muscles, for example after a stroke or spinal cord injury. Weakness may be present too. UCLH explains that some people partly rely on leg stiffness to stand or transfer. Reducing it without considering the task can therefore have an unwanted practical effect.

Show or describe the activity you want to change. If hand hygiene is the priority, improvement is assessed differently from improvement in stepping. One goal is not inherently more valid than the other. The clinician needs to understand which difference would help this particular person.

When stiffness suddenly increases

Note when the change occurred and whether there is pain, fever, a urinary problem, a skin problem or uncomfortable positioning. Irritation and another health problem can aggravate symptoms. Simply increasing the rehabilitation workload without examining a new trigger may miss the underlying issue.

Report new medicines, schedule changes and missed prescriptions. Do not independently stop antispasticity medicines; abrupt withdrawal of some treatments is dangerous. A marked deterioration in general health needs local medical assessment rather than waiting for a course abroad.

Connecting treatment options to the goal

A plan may include positioning, movement therapy, medicines or selected procedures. What is appropriate depends on the muscles involved, the reasons an activity is limited and the intended result. A diagnosis alone cannot identify the right injection or piece of equipment.

Ask the team to explain how each proposed intervention serves the goal. If a local procedure is discussed, establish which activity will be practised afterwards, who will provide therapy and when the result will be assessed. Completion of a procedure is not proof that an everyday objective has been achieved.

Information to prepare for the team

Bring the medication list, previous procedure details and their effects, information about orthoses and the assistance currently required. Report unwanted changes as well as improvements: sleepiness, weakness or more difficult transfers after earlier treatment may be relevant. A companion can describe care tasks, but the patient’s own priorities should remain part of the discussion.

Before travelling, agree on follow-up after the course and identify a local clinician who can continue care. A plan for care after returning home is especially important if treatment needs continued monitoring or repeat procedures. Rehabilitation should not lose its clinical follow-through on the day of the return flight.

Sources

• UCLH: Managing spasticity