Treatment Options
In some patients with mild spasticity, the best treatment may be no treatment, with a watch-and-wait strategy. Typically, treatment is reserved for spasticity that causes pain, interferes with activities of daily living or sleep, leads to increasing levels of functional disability, or poses problems for care. Some key questions that should be answered before beginning any treatment for spasticity include:
- Is treatment necessary?
- Do the patient and caregiver have the time and resources necessary to put the treatment into action?
- Will the treatment improve the patient’s or the caregiver’s quality of life?
Treatment Goals
Patient and family expectations regarding the possibilities of treatments and outcomes may be realistic or unrealistic. Inappropriate expectations about the effectiveness of treatment may lead to disappointment regarding relief of symptoms and spasticity-related pain. Therefore, ongoing communication and agreement by the patient, caregivers, and healthcare professionals regarding the goals of treatment are extremely important. The following list includes goals that are commonly developed in the treatment of spasticity.
- Relieve the signs and symptoms of spasticity
- Reduce pain, frequency of spasms, or irritating stimuli
- Improve gait, hygiene, activities of daily living, or ease of care
- Reduce problems with passive function, that is, the functions provided by the caregiver, such as dressing, feeding, transfer, and bathing
- Improve voluntary active motor function, that is, the behaviors and functions that are under the patient’s control, such as reaching for, grasping, moving, and releasing an object
Measurement of Treatment Effectiveness
Obtaining information on the response of spasticity to treatment is often difficult because the degree of spasticity changes throughout the day in an individual, throughout the course of the disease that causes the spasticity, and in response to various stimuli. Therefore, it is important, when measuring response to treatment, to have the assessment take place at the same time of day, in the same environment, and using the same measuring techniques and devices.
As mentioned in the section on assessment of spasticity, rating scales may be used to evaluate response to therapy. A combination of rating instruments is often necessary because none cover all areas of importance. The choice of evaluation tools is dependent upon expected change. Scales that are often used in the rating of spasticity include:
- The Ashworth scale, a 5-point scale
- The modified Ashworth scale, a 6-point scale
- The spasm frequency scale, a 4-point scale
- The reflex score, a 5-point scale
- A functional scale (i.e. the Fugl-Meyer scale)
Types of Treatment
A combination of various types of treatment is usually required to attain the specific goals of treatment for a particular patient. Most people with spasticity require physical and occupational therapy to improve or maintain the range of motion in their spastic limbs.
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