Spasticity in children

NewsBot · Jul 25, 2012

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NICE have released their policy statement and guidelines on:
Spasticity in children and young people with non-progressive brain disorders
Management of spasticity and co-existing motor disorders and their early musculoskeletal complications (PDF file)

Admin2 · Jul 26, 2012

Related:
Other thread on cerebral palsy

NewsBot · Sep 6, 2014

Spasticity in Children with Cerebral Palsy?
Willerslev-Olsen, Maria
Thesis PhD. University of Copenhagen

During the past 30 years spasticity research has raised fundamental concerns regarding the definition, evaluation and functional significance of spasticity. The present thesis is a direct continuation of this work. The aim of the thesis was to evaluate reflex mediated stiffness (spasticity) and passive stiffness (changes in the elastic properties of muscles) of ankle joint muscles at rest, during gait and in relation to gait training in children with cerebral palsy (CP). In study I we found that reflex mediated stiffness is difficult to distinguish clinically from changes in passive muscle stiffness and notably that passive muscle stiffness rather than increased reflex stiffness (spasticity) is the most frequent explanation of ankle muscle hyper tonicity in children with CP. These findings emphasises the importance of properly distinguishing different contributions to muscle stiffness in order to avoid unnecessary antispastic treatment. Findings from study II suggested that spasticity is not the main functional limitation for movement of the ankle joint during gait in children with CP. Despite relative exaggeration of reflexes during gait, unloading of the active plantar flexors produced a similar or in some cases a smaller drop in the soleus EMG activity in the children with CP compared to control children. This indicates that sensory feedback mechanisms contribute less to the soleus EMG activity in children with CP than in control children. We thus argue that exaggeration of reflex activity is unlikely to contribute to foot drop and toe walking in the children with CP. Antispastic treatment is therefore unlikely to benefit the children functionally and we argue that therapy and treatment strategies should rather be directed at passive muscle changes. Study III was performed in order to explore whether intensive gait training on a treadmill with incline could reduce passive muscle stiffness in the ankle joint and maybe facilitate a more appropriate heel strike in children with CP. The study demonstrated that children with increased passive stiffness prior to intervention significantly reduced passive stiffness following training. This indicates that it is possible to reverse the development of passive muscle stiffness and maybe even prevent the development of contractures if the problem is revealed sufficiently early. These three studies together highlight the essence of proper clinical evaluation in order to ensure the most optimal treatment and intervention for the individual child. Interventions involving physical activity and specific training may be more appropriate solutions than antispastic therapy for many of the children.
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NewsBot · Feb 11, 2021

Assessments and Interventions for Spasticity in Infants With or at High Risk for Cerebral Palsy: A Systematic Review
Lauren Ayala et al
Pediatr Neurol. 2020 Nov 4;S0887-8994(20)30349-0

Background: The majority of children with cerebral palsy develop spasticity, which interferes with motor development, function, and participation. This systematic review appraised current evidence regarding assessments and interventions for spasticity in children aged less than two years with or at high risk for cerebral palsy and integrated findings with parent preferences.

Methods: Five databases (CINAHL, EMBASE, OVID/Medline, SCOPUS, and PsycINFO) were searched. Included articles were screened using PRISMA guidelines. Quality of the evidence was reviewed by two independent reviewers using Quality Assessment of Diagnostic Accuracy Studies, second edition (QUADAS-2), the RTI Item Bank on Risk of Bias and Precision of Observational Studies (RTI), or The Cochrane Collaboration's tool for assessing risk of bias in randomized trials (RoB). An online survey was conducted regarding parent preferences through social media channels.

Results: Twelve articles met inclusion criteria. No high-quality assessment tool emerged for this population. Six interventions (botulinum toxin-A, orthotic use, radial extracorporeal shock wave therapy, erythropoietic stimulating agents, medical cannabis, and homeopathy) were identified. There was low-quality evidence for the use of botulinum toxin-A and radial extracorporeal shock wave therapy to improve short-term outcomes. Survey respondents indicated that spasticity assessments and interventions are highly valued, with nonpharmacologic interventions ranked most preferably.

Conclusions: Further research is needed to validate assessments for spasticity in children younger than two years. Conditional recommendations can be made for botulinum toxin-A and radial extracorporeal shock wave therapy based on low level of evidence to reduce spasticity in children aged less than two years
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NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

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