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Printed at: 11:51:21 / 18-04-2021

Management of increased muscle tone

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Does this information apply to me?
Yes, if you are:
– a young person with increased tone (spasticity) as a result of a non-progressive brain disorder, such as cerebral palsy.
– a parent or carer of a child or young person with increased tone (spasticity) as a result of a nonprogressive brain disorder, including those with spasticity resulting from cerebral palsy.

Non-progressive means that the problems in the brain have already happened and will not worsen. However, the effects of the brain disorder may change as the child grows and develops.

No, if you are:
– a young person, or the parent or carer of a child or young person with spasticity resulting from a progressive brain disorder
– someone who does not have spasticity but has a condition called dystonia or other motor disorder.

What is increased muscle tone or spasticity?
Spasticity is a condition that affects the muscles, making them more stiff and rigid than usual, and it may be accompanied by other problems such as uncontrolled movements. It is caused by problems with the part of the brain that controls movement. Spasticity most commonly affects the legs and arms, but it can also affect any part of the body – for example, the trunk, neck and face. It can cause problems with posture, sitting, walking, hand and arm movements, speech and swallowing. It can also cause discomfort, pain, cramps and spasms.

Cerebral palsy is the most common cause of spasticity in children and young people. Cerebral palsy includes various conditions that affect muscle control and movement. In children who are born with a brain injury causing cerebral palsy, spasticity may not be present at birth and may only become evident over time. In other cases, spasticity may occur later in childhood or adolescence – for example, as a result of a serious head injury.

Treatment
Once you or your child has been  diagnosed with spasticity they should be referred to a team of healthcare professionals who will provide and coordinate the care that you or your child needs. This team will work in partnership with you and your child to develop and carry out a management programme that includes specific treatment goals and takes into account the possible impact of any treatment on your child and the rest of your family.

Goals for physiotherapy treatment might include:
– improving motor function (for example walking or transferring in and out of a chair) and posture
– enhancing you or your child’s ability to take part in everyday activities
– easing pain and discomfort, including muscle spasms
– preventing or delaying the possible complications of spasticity, such as contractures (abnormal shortening of the muscle) which can lead to poor posture and decreased function.

Physiotherapy can help with:
. posture
. enhancing skill development
. function/ carrying out daily tasks
. preventing pain or contractures
. muscle strengthening
. muscle stretching
. handling a child with increased tone as handling can influence muscle tone

It is important to understand the complications which may arise if physiotherapy advice is not followed.

For example:
Poor posture which may lead to further musculoskeletal problems such as:

Scoliosis (curvature of the spine)
Contractures (permanent shortening of the muscle which prevents normal movement)
Hip displacement (meaning the hip becomes partially dislocated)
Reduced function and decreased independence
Reduced muscle strength

Multi-disciplinary Team
Physiotherapy is just one part of the tone management team and treatment works best when you and/or your child engage with the entire team. Other team members that you may be referred to include:

Occupational therapy
Orthopaedics
Orthotics
Paediatrician
Speech and language
Neurology