Spasticity in children and young people with non-progressive brain disorders: summary of NICE guidanceBMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e4845 (Published 26 July 2012) Cite this as: BMJ 2012;345:e4845
- Moira A Mugglestone, director of guideline development1,
- Paul Eunson, consultant paediatric neurologist2,
- M Stephen Murphy, clinical co-director (children’s health)1, senior lecturer in paediatrics and child health3, consultant paediatric gastroenterologist4
- on behalf of the Guideline Development Group
- 1National Collaborating Centre for Women’s and Children’s Health, London W1T 2QA, UK
- 2Royal Hospital for Sick Children, Edinburgh EH9 1LF, UK
- 3College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
- 4Birmingham Children’s Hospital NHS Foundation Trust, Birmingham B4 6NH
- Correspondence to: M A Mugglestone
Spasticity is a form of hypertonia1 and is associated with conditions such as cerebral palsy, which affects 110 000 people in the United Kingdom.2 More than 2000 children born this year in the UK will develop spasticity, which, if unmanaged, will cause pain, affect quality of life, and may lead to complications requiring major surgery. Children and young people with spasticity need early referral to local services that will meet their individual needs and allow them access to the range of interventions that will encourage their motor development. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the management of spasticity in children and young people with non-progressive brain disorders, including those with cerebral palsy.3
NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.
Principles of care
Children and young people with spasticity should have access to a network of care that uses agreed care pathways supported by effective communication and integrated team working, and provides access to healthcare professionals experienced in the care of such people. The network team should provide local expertise in paediatrics, nursing, physiotherapy, and occupational therapy. Access to other expertise, including orthotics, orthopaedic surgery (and/or neurosurgery), and paediatric neurology, may be provided locally or regionally.
If a person receives treatment for spasticity from healthcare professionals outside the network team, this should be planned and undertaken in discussion with the network team to ensure integrated care and effective subsequent management.
[Both points based on the experience and opinion of the Guideline Development Group (GDG)]