Spasticity: a rehabilitation challenge in the elderly

There is no doubt that spasticity is a significant cause of disability in the elderly. Regrettably, it is a condition that is often poorly treated and can result in a range of unnecessary complications which can cause further problems for the disabled person and their family. There are now a number of effective treatment options. However, before such options are defined the specific goals of rehabilitation need to be clarified and an appropriate outcome measure chosen in order to determine when such goals are being met. The treatment should be multidisciplinary and input from both the physician and a physiotherapist is essential. Involvement of the elderly person with spasticity, and often their family, is also important in the education process. Simple physiotherapy interventions can be remarkably helpful, including attention to positioning and seating. The role of the physician initially focuses on oral medication. Although we still have older drugs including diazepam, baclofen and dantrolene there are now more modern drugs including tizanidine and, more recently, gabapentin. However, most spasticity is focal in origin and thus requires focal treatment. Although phenol nerve blocks are sometimes helpful the use of botulinum toxin is now to be highly recommended. There is now clear evidence of the efficacy of botulinum toxin, which has been a significant advance in our management of spasticity. More advanced and difficult to treat problems can be alleviated by intrathecal baclofen or sometimes intrathecal phenol or, as a last resort, surgical intervention. The advent of lycra garments for the overall management of more diffuse spasticity is now becoming both fashionable and effective.

The management of spasticity in the elderly person is a significant challenge to the rehabilitation team and a combined approach can produce significant benefit for the disabled elderly person.