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12 - Management of spasticity in children

Published online by Cambridge University Press:  22 August 2009

By
Rachael Hutchinson  and
H. Kerr Graham
Edited by
Michael P. Barnes  and
Garth R. Johnson
Rachael Hutchinson
Affiliation:
Consultant Paediatric Orthopaedic Surgeon Norfolk and Norwich University Hospital NHS Trust, Norfolk, UK
H. Kerr Graham
Affiliation:
Professor of Orthopaedic Surgery Royal Children's Hospital, Melbourne, Australia
Michael P. Barnes
Affiliation:
University of Newcastle upon Tyne
Garth R. Johnson
Affiliation:
University of Newcastle upon Tyne
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Summary

Introduction

Spasticity can be defined as a velocity-dependent resistance to passive movement of a joint and its associated musculature (Lance, 1980; Rymer & Powers, 1989; Massagli, 1991). Although spasticity is usually present before contracture in children with cerebral palsy, true muscle shortening or contracture also appears at an early stage. The majority of children will have a mixture of spasticity and contracture. Distinguishing spasticity from contracture is important from a management point of view.

  1. ‘Dynamic’ shortening is most commonly caused by spasticity but may also be associated with dystonia and mixed movement disorders. Typically, ‘dynamic’ contracture is recognized in younger children with cerebral palsy or spasticity of recent onset. Such children are likely to exhibit hyperreflexia, clonus, co-contraction and a velocity-dependent resistance to passive joint motion. Children who exhibit ‘dynamic’ calf shortening may walk on their toes with an equinus gait, but on the examination couch the range of passive ankle dorsiflexion may be full or almost full.

  2. ‘Fixed’ shortening or ‘myostatic’ contracture describes the typical stiffness found in muscles of older children with cerebral palsy or spasticity of longer duration. The stiffness is much less velocity dependent and is still present during couch examination and under anaesthesia.

Causes of spasticity in children

With the eradication of poliomyelitis and the dramatic fall in the prevalence of spina bifida, the most common motor disorder in children in developed countries is cerebral palsy. The incidence of cerebral palsy in developed countries is static or even rising.

Keywords

Ashworth scalesbotulinum toxincerebral palsymusculoskeletal pathologytraumatic brain injuryspinal cord injuryspasticity
Type
Chapter
Information
Upper Motor Neurone Syndrome and Spasticity
Clinical Management and Neurophysiology
 , pp. 214 - 240
Publisher: Cambridge University Press
Print publication year: 2008

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  • Management of spasticity in children
    • By Rachael Hutchinson, Consultant Paediatric Orthopaedic Surgeon Norfolk and Norwich University Hospital NHS Trust, Norfolk, UK, H. Kerr Graham, Professor of Orthopaedic Surgery Royal Children's Hospital, Melbourne, 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/CBO9780511544866.013
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  • Management of spasticity in children
    • By Rachael Hutchinson, Consultant Paediatric Orthopaedic Surgeon Norfolk and Norwich University Hospital NHS Trust, Norfolk, UK, H. Kerr Graham, Professor of Orthopaedic Surgery Royal Children's Hospital, Melbourne, 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/CBO9780511544866.013
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  • Management of spasticity in children
    • By Rachael Hutchinson, Consultant Paediatric Orthopaedic Surgeon Norfolk and Norwich University Hospital NHS Trust, Norfolk, UK, H. Kerr Graham, Professor of Orthopaedic Surgery Royal Children's Hospital, Melbourne, 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/CBO9780511544866.013
Available formats
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