Spasticity Management in Neurological Conditions. A Quick-Start Guide George F. Wittenberg MD PhD 28 January 2010. Outline. The Upper Motor Neuron Syndrome Spasticity Management through Oral Medications Spasticity Management through Parenteral Medications Botulinum Toxins
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A Quick-Start Guide
George F. Wittenberg MD PhD
28 January 2010
Positive Signs(Excessive normal resting state)
Negative Signs(Less than normal resting state)
Young RR, Emre M, Nance PW, et al. Current issues in spasticity management. Neurologist. 1997; 3:261-275.
Young RR. Treatment of spastic paresis. N Engl J Med. June 1989;320(23):1553-1555.
0. No increase in muscle tone
(1) Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the range of motion when the affected part(s) is moved in flexion or extension.
(1+) Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the reminder (less than half) of the ROM (range of movement).
(2) More marked increase in muscle tone through most of the ROM, but affected part(s) easily moved.
(3) Considerable increase in muscle tone passive, movement difficult.
(4) Affected part(s) rigid in flexion or extension.
(Original Ashworth score in parentheses; Modified after Bohannon and Smith Phys Ther. 1987 Feb;67(2):206-7.
Always assume it’s the Intrathecal Baclofen
*Meythaler JM, Roper JF, Brunner RC. Cyproheptadine for intrathecal baclofen withdrawal. Arch Phys Med Rehabil 2003; 84:638-642.