If muscle stiffness, spasms or tightness are making daily tasks harder, your child may be battling spasticity. Our team of experts works to reduce symptoms, eliminate discomfort, improve movement of the arms and legs and help your child gain independence.
Understanding spasticity
Understanding spasticity
Spasticity, also known as muscle spasticity, is abnormally increased muscle tone with involuntary muscle contractions and exaggerated stretch reflexes. Individuals with spasticity are unable to control these abnormal movements of their muscles, meaning that their bodies are essentially “fighting” against them when they try to move. While spasticity can limit range of motion and make everyday activities like walking, sitting and getting dressed harder and sometimes painful, the good news is that there are effective ways to treat the condition.
Spasticity may also be described using related terms:
- Spastic paralysis refers to muscle stiffness and weakness caused by damage to the brain or spinal cord.
- Spastic cerebral palsy, the most common type of cerebral palsy, involves lifelong muscle tightness and movement challenges that begin in early childhood.
- Hereditary spastic paraplegia is a genetic condition marked by gradually worsening muscle stiffness and weakness, most often in the legs.
Causes of spasticity
Causes of spasticity
Spasticity is caused by damage or disruption in the central nervous system pathways that help regulate muscle tone and movement. With this condition, the brain and spinal cord send mixed signals to the muscles, causing them to contract involuntarily in an uncontrolled fashion. It is very common in children with cerebral palsy, certain congenital conditions like hereditary spastic paraplegia, or after brain and spinal cord injuries.
Risk factors for spasticity
Risk factors for spasticity
Although the exact cause of the underlying neurologic injury is not always known, spasticity most often results from damage to the areas in the brain or spinal cord that affect movement control. Risk factors include neurologic conditions or injuries such as cerebral palsy, spinal cord injury, stroke or traumatic brain injury. In some cases, spasticity is inherited, and a family history of certain neurologic disorders, such as hereditary spastic paraplegia, is more strongly associated with the condition.
How is spasticity diagnosed?
How is spasticity diagnosed?
Spasticity is assessed by a multidisciplinary team of specialists that may include Neurosurgery, Orthopedic Surgery, Physical Medicine & Rehabilitation and Physical Therapy. Initial assessment includes a physical exam focusing on muscle tone, range of motion, and identification of which muscles are affected. A clinical evaluation reviews symptoms like stiffness and spasms, functional concerns and limitations, and how the symptoms negatively affect daily tasks.
Advanced technology like 3D Gait analysis uses cameras and sensors to create a three-dimensional picture that dynamically assesses how your child walks, and it may be recommended by our team to help guide specific interventions.
How is spasticity treated?
How is spasticity treated?
When deciding on the best approach to treat spasticity, specialists consider how spasticity affects the body along with the underlying diagnosis, the child’s and family’s functional goals, and how they have responded to past therapies or medications. The team then talks with families about the potential benefits and risks of each option, what recovery may look like and the therapy or rehabilitation plan needed to achieve the best results. Together, families and providers choose a treatment plan focused on improving comfort, movement and quality of life.
Nonsurgical treatment options
Therapy and rehabilitation
Physical therapy includes stretching, strengthening, and range-of-motion exercises designed to improve mobility and reduce muscle tightness. Occupational therapy includes strategies and tools to make daily tasks easier and support independence.
Medications
Oral medicines may be used to reduce muscle tightness and spasms; your care team will review potential side effects. Options may include baclofen, valium, dantrolene or tizanidine. These are often used alongside other therapies to support daily functioning and sleep.
Botox or phenol injections are targeted injections that relax specific muscles for a few months at a time and can be helpful for children with significant spasticity in specific muscle groups.
Supportive devices and braces
Serial casts can improve range of motion and loosen muscles that are abnormally rigid or spastic by gradually increasing the length and flexibility of the muscle with a series of casts applied over time.
Procedures and surgical options
When appropriate, advanced interventions may be considered when spasticity is severe, persistent, or limiting function despite therapy and medication. While final candidacy is individualized, common candidates include children whose spasticity is affecting walking, sitting, hygiene, sleep or the ability to participate in therapy. The ultimate goals of procedural care offered by our Surgical Spasticity Program vary by patient and include reducing abnormal muscle tone and painful spasms, improving independent mobility such as walking, improving range of motion and positioning, making daily tasks easier and supporting comfort and caregiving.
Intrathecal Baclofen (ITB) Therapy / Baclofen pump
ITB therapy involves a mechanical pump that is surgically implanted under the skin to deliver baclofen medication directly into the spinal fluid through a small catheter. This provides better spasticity control with fewer side effects than oral baclofen. It may be considered for widespread or severe spasticity when oral medications cause side effects or do not provide enough relief.
Selective Dorsal Rhizotomy (SDR)
A selective dorsal rhizotomy, or SDR, is a neurosurgical procedure that selectively cuts certain sensory nerve rootlets in the spine to reduce abnormal reflex activity that contributes to spasticity in the legs. This can improve walking and mobility, and it is most often recommended for children with spastic cerebral palsy who are able to stand and take steps, with or without assistance.
Non-Selective Ventral-Dorsal Rhizotomy (VDR)
This permanent procedure reduces overall leg muscle tone, including spasticity and dystonia, which leads to pain relief and improves ease of care for children who use wheelchairs.
Nerve-targeting procedures
In patients with focal spasticity in specific muscle groups, procedures that target selected nerves may be considered to reduce muscle overactivity while preserving useful function.
Orthopedic surgery
Over time, uncontrolled spasticity can lead to permanent shortening of muscle and tendons (contractures) or dislocations (subluxations) of certain joints such as the hips. Orthopedic procedures may be used to help improve positioning, joint motion, comfort and/or walking mechanics by directly treating contractures and subluxations. These procedures address the secondary effects of spasticity on the muscles/joints and are often paired with rehabilitation. Orthopedic surgeries may include tendon lengthening or muscle-tendon releases, as well as bone/joint procedures such as guided growth to help improve alignment of the joints.
Deep brain stimulation (DBS)
Deep brain stimulation, or DBS, is a procedure that uses electrodes placed in the brain to send gentle electrical signals to help normalize muscle activity. DBS is often used when patients have severe dystonia.
Riley Children’s approach to spasticity care
Our multidisciplinary pediatric experts work as a team to evaluate spasticity and dystonia, determine the best treatment options, and create a personalized care plan—often in a single, coordinated visit. In addition to medical and surgical planning in our Surgical Spasticity Program, our care team provides education on safe movement and home stretching, along with support to help families navigate therapy plans and follow‑up care. Our goal is to improve movement, reduce pain, and enhance quality of life through coordinated, timely care.
Research
Research
Our team actively participates in the Cerebral Palsy Research Network (CPRN) Registry, helping contribute to a national database that improves care and outcomes for children with cerebral palsy, including treatments for spasticity.
Key Points to Remember
- Spasticity can be treated non-surgically, surgically, or a combination of both
- Your child will typically see a coordinated care team of experts all in one appointment, including orthopedic surgeons, neurosurgeons, physical therapists and rehabilitation specialists
- Specialized pediatric services and programs at Riley Children’s Health include our Cerebral Palsy Program, Movement Disorders services and Surgical Spasticity Program
- Our Surgical Spasticity Program is the only program like it in Indiana