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Rehabilitation of spasticity and related problems in childhood cerebral palsy
1The Department of Child & Adolescent Development and Rehabilitation, Women's and Children's Hospital, North Adelaide, South Australia, Australia. flettp@wch.sa.gov.au
Insights
Advances in managing spasticity in children with cerebral palsy include botulinum toxin A injections and emerging intrathecal baclofen. Physical therapy remains critical for functional improvement.
Area of Science:
- Neurology
- Pediatrics
- Rehabilitation Medicine
Background:
- Spasticity is a common and debilitating component of childhood cerebral palsy, impacting function and leading to musculoskeletal issues.
- Recent years have seen significant advancements in managing spasticity and associated problems in pediatric cerebral palsy.
- Effective management is crucial for improving quality of life and functional outcomes in affected children.
Purpose of the Study:
- To critically review current and emerging therapies for managing spasticity in childhood cerebral palsy.
- To provide an Australian perspective on the availability and application of these treatments.
- To highlight the integrated role of medical, surgical, and therapeutic interventions.
Main Methods:
- Literature review of recent advancements in antispasticity management.
- Analysis of treatment modalities including pharmacological, surgical, and physical therapy approaches.
- Focus on therapies relevant to the Australian healthcare context.
Main Results:
- Botulinum toxin A is a leading treatment, offering long-lasting, localized spasticity control with a favorable side-effect profile.
- Intrathecal baclofen shows emerging promise, while selective dorsal rhizotomy remains less common in Australia.
- Oral medications, including newer agents and combination therapies, continue to play a role.
- Orthopaedic surgery approaches have evolved, and physical therapy is indispensable for functional assessment and rehabilitation.
Conclusions:
- A multimodal approach integrating pharmacotherapy, targeted injections, evolving surgical options, and comprehensive physical therapy is essential for optimal spasticity management in childhood cerebral palsy.
- Botulinum toxin A represents a significant therapeutic advance for focal spasticity.
- Continued research and adaptation of treatment strategies are necessary to improve functional outcomes and address musculoskeletal complications.
Abstract:
Spasticity is one part of the upper motor neuron syndrome, but it is a widespread problem in cerebral palsy; it is debilitating, affects function and can lead to musculoskeletal complications. Significant advances have occurred in antispasticity management (and related musculoskeletal problems) in children with cerebral palsy during the past 5-10 years. Botulinum toxin A has been the most outstanding treatment advance; it is relatively long-lasting, easy to administer, reversible, has a favourable side-effect profile and is highly useful for focal spasticity. There is an emerging role for intrathecal baclofen in Australia. Despite being available and practised in North America for years, selective dorsal rhizotomy has not been popular in Australia. The use of orthopaedic surgery has significantly altered in recent years. There is still a place for oral drug treatment, including some newer agents and the potential for combination treatment with other modalities. The role of physical therapy in defining disability, assessing function, undertaking biomechanical assessment and providing mobility aids/casting/orthoses and motor training/stretching exercises is critical for the success of medical and surgical interventions. From an Australian perspective, the purpose of the present review is to provide a critical review of therapies available for spasticity associated with childhood cerebral palsy.
