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4 - Physiotherapy management of spasticity

Published online by Cambridge University Press:  22 August 2009

By
Roslyn N. Boyd  and
Louise Ada
Edited by
Michael P. Barnes  and
Garth R. Johnson
Roslyn N. Boyd
Affiliation:
Associate Professor, Scientific Director Queensland Cerebral Palsy and Rehabilitation Research Centre, Department of Paediatrics and Child Health, University of Queensland, Brisbane, Australia
Louise Ada
Affiliation:
Associate Professor Discipline of Physiotherapy University of Sydney Sydney, Australia
Michael P. Barnes
Affiliation:
University of Newcastle upon Tyne
Garth R. Johnson
Affiliation:
University of Newcastle upon Tyne
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Summary

In the past, much of the controversy about the management of spasticity has been due to a lack of commonly accepted definitions of the disorder, the difficulty in measuring spasticity as well as the changing nature of the motor activity limitations with growth and maturation. There was also a paucity of data to validate clinical practice. However, there is now a growing body of evidence on which to base clinical practice. While many disciplines are involved in the management of spasticity, physiotherapists have a unique role in applying their understanding of the biomechanics of movement to the analysis of motor activity limitations and their knowledge of motor learning principles to reduce activity limitations. The emphasis of this chapter is on improving muscle performance in order to enable activity rather than preparing the patient for function by affecting abnormal reflex activity. In addition, we discuss the physiotherapist's goal in using orthoses and the role of physiotherapists in pharmacological and surgical interventions. Clinical applications for children with cerebral palsy and adults after stroke are highlighted because these individuals are the largest groups with brain damage.

What is spasticity?

Spasticity is one of the impairments affecting function following brain damage. It is typical to consider the impairments associated with the upper motor neurone syndrome as either positive or negative. Negative impairments are those features that have been lost following brain damage (e.g. loss of strength and dexterity), whereas positive impairments are those features which are additional (e.g. spasticity and abnormal postures) (Jackson, 1958; Landau, 1980; Burke, 1988).

Keywords

cerebral palsyclinical managementimpairmentsphysiotherapistsSpasticity
Type
Chapter
Information
Upper Motor Neurone Syndrome and Spasticity
Clinical Management and Neurophysiology
 , pp. 79 - 98
Publisher: Cambridge University Press
Print publication year: 2008

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  • Physiotherapy management of spasticity
    • By Roslyn N. Boyd, Associate Professor, Scientific Director Queensland Cerebral Palsy and Rehabilitation Research Centre, Department of Paediatrics and Child Health, University of Queensland, Brisbane, Australia, Louise Ada, Associate Professor Discipline of Physiotherapy University of Sydney Sydney, Australia
  • Edited by Michael P. Barnes, University of Newcastle upon Tyne, Garth R. Johnson, University of Newcastle upon Tyne
  • Book: Upper Motor Neurone Syndrome and Spasticity
  • Online publication: 22 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544866.005
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  • Physiotherapy management of spasticity
    • By Roslyn N. Boyd, Associate Professor, Scientific Director Queensland Cerebral Palsy and Rehabilitation Research Centre, Department of Paediatrics and Child Health, University of Queensland, Brisbane, Australia, Louise Ada, Associate Professor Discipline of Physiotherapy University of Sydney Sydney, Australia
  • Edited by Michael P. Barnes, University of Newcastle upon Tyne, Garth R. Johnson, University of Newcastle upon Tyne
  • Book: Upper Motor Neurone Syndrome and Spasticity
  • Online publication: 22 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544866.005
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  • Physiotherapy management of spasticity
    • By Roslyn N. Boyd, Associate Professor, Scientific Director Queensland Cerebral Palsy and Rehabilitation Research Centre, Department of Paediatrics and Child Health, University of Queensland, Brisbane, Australia, Louise Ada, Associate Professor Discipline of Physiotherapy University of Sydney Sydney, Australia
  • Edited by Michael P. Barnes, University of Newcastle upon Tyne, Garth R. Johnson, University of Newcastle upon Tyne
  • Book: Upper Motor Neurone Syndrome and Spasticity
  • Online publication: 22 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544866.005
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