Abstract
Spasticity can cause significant problems with activity and participation for people with a variety of neurological disorders. It can also represent a major challenge to the rehabilitation team. However, modern approaches to management, making the best use of new drugs and new techniques can produce significant benefits for the disabled person. The details of these techniques are outlined in this report. The purpose of this report is to provide a general overview of spasticity management therapies, especially intrathecal baclofen (ITB), selective dorsal rhizotomy (SDR), and selective peripheral neurotomy (SPN). ITB is used in patients with widespread spasticity in whom alternative methods of spasticity management are ineffective or inadequate or cause unacceptable side effects. A trial dose of intrathecal baclofen is first administered to demonstrate that ITB will make a significant impact on the level of spasticity. After implantation surgery, pumps are refilled percutaneously by injection through the filling port every three months. Catheter or pump failure leads to a sudden withdrawal of medication, which can occasionally cause a serious withdrawal syndrome of high fever, hallucination, impaired consciousness, spasticity, and multiple organ failure. SDR is a surgical procedure to treat CP children by selectively cutting the dorsal rootlets from L2 to S1 based upon their responses to electrical stimulation. SDR has a long history of use worldwide and is a well-recognized treatment for children with spastic cerebral palsy. SDR has several variations that can be classified into two groups, wide laminectomy and limited laminotomy. Each technique has its advantages and disadvantages, but a number of publications have confirmed the efficacy of the various dorsal rhizotomy techniques. SPNs are indicated when spasticity is localized to the muscles or muscular groups supplied by a single or a few peripheral nerves that are easily accessible. The general rule is to tailor individual treatments as much as possible to the particular problems of the patient.
