The technical definition is ‘velocity-dependent increased resistance to passive limb movement in people with upper motor neurone syndrome’ (Lance 1980).

At a clinical level, there are two main contributing factors to resistance to movement in the context of limb spasticity following damage to the brain or spinal cord:

• neurogenic component: overactive muscle contraction
• biomechanical component: stiffening and shortening of the muscle and other soft tissues

Harmful effects of spasticity include:

• pain
• difficulty with seating and posture
• fatigue
• contractures
• pressure sores
• deformity
• distress and low mood
• poor sleep patterns
• reduced function and mobility
• difficulty with self care and hygiene

Spasticity is not always harmful. Patients with a combination of muscle weakness and spasticity may rely on the increased tone to maintain their posture and aid standing or walking.

Clinical management issues to consider

Prevention of aggravating factors:

• pain or discomfort
• constipation
• infection (eg. urinary or respiratory tract infection, pressure sores etc.)
• tight clothing or catheter bags
• poor postural management

24-hour postural management programme

• document range of movement (ROM) of arms and legs (can patient feed self, lay down straight and sit in a chair?)
• consider a ‘tilt in space’ wheelchair if it facilitates early mobilisation

Physical therapy aims

• maintain muscle and soft tissue length across joints
• facilitate care giving (passive functional improvements)
• facilitate active control of any residual movements to allow for active participation in tasks (active functional improvements)

Medical treatment (in conjunction with physical therapy)

• consider whether the spasticity is actually harmful and what impact treatment will have in the patient’s functioning
• consider pattern of spasticity: generalised, focal or multi-focal problems
• quantify spasticity using Modified Ashworth Scale

A management strategy can be a combination. While formulating such strategy, consider:

• the different medications (eg. baclofen, tizanidine, gabapentin) and strategies available and their potential uses. If spasticity is combined with neurogenic pain, consider gabapentin as first choice
• mode of administration (pharmacology) and dosing / technique used
• mechanism of action of treatment(s) chosen
• side effects, precautions and potential complications