Clinical Review

The management of spasticity in adults

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g4737 (Published 05 August 2014) Cite this as: BMJ 2014;349:g4737
  1. Krishnan Padmakumari Sivaraman Nair, consultant1,
  2. Jonathan Marsden, professor2
  1. 1Department of Neurology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  2. 2School of Health Professions, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
  1. Correspondence to: K P S Nair siva.nair{at}sth.nhs.uk

Summary points

  • Spasticity is a frequent and debilitating feature of common neurological conditions such as stroke, multiple sclerosis, and traumatic brain and spinal cord injuries

  • The disorder is often associated with pain and discomfort and increased care needs

  • Spasticity is difficult to manage and requires a collaborative approach involving multiple disciplines

  • The evidence for both drug and non-drug treatments of spasticity is limited

  • More research is required to determine the effectiveness of various treatments of spasticity

Spasticity is a common disorder affecting people with long term neurological conditions such as stroke, multiple sclerosis, and traumatic brain and spinal cord injuries. A systematic review of 24 studies on the epidemiology of leg spasticity reported a prevalence of 28-38% in patients with stroke, 41-66% in patients with multiple sclerosis, and 13% in patients with traumatic brain injury.1

Spasticity varies from a subtle neurological sign to a gross increase in tone causing immobility of joints. The disorder is associated with several complications, including falls, pain, pressure ulcers, infections, and contractures,2 although it is not clear whether these complications are caused by spasticity or co-exist independently.1 Spasticity increases care needs and utilisation of healthcare resources,3 and carers of patients with spasticity are more likely to experience anxiety and depression.4 Some patients may make use of their spasticity to sit, stand, walk, or transfer. Management of spasticity requires a balanced approach, weighing the benefits of treatment against the usefulness of the spasticity. Current interventions to treat spasticity lack a robust evidence base, and guidelines often depend on expert recommendations. This review discusses the assessment and treatment of spasticity in adults.

Sources and selection criteria

We searched the databases PubMed, AMED, Embase, Medline, British Nursing Index, and CINAHL using the keywords “spasticity”, “contracture”, “upper motor neurone”, and “muscle tone” from 2004 to 2014. We based this review …

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