Spasticity Management for Cerebral Palsy in Children

Doctors at Hassenfeld Children’s Hospital at NYU Langone manage spasticity, which refers to overly tight or contracted muscles, in children with cerebral palsy. This is the most common physical characteristic of this condition.

Children with spasticity often have difficulty bending or straightening joints in the hips, knees, ankles, shoulders, elbows, and wrists. When children attempt to use these muscles, their movements may appear uneven or jerky. As children grow and muscles become increasingly stiff, spasticity can lead to abnormalities in joints that cause conditions such as hip displacement and scoliosis.

Our neuromuscular experts work together to provide children who have cerebral palsy with the care they need to relieve spasticity and prevent progressive damage to muscles and joints. Twice each week, they host a spasticity clinic to provide children and their families with an opportunity to meet with doctors from a variety of disciplines, all of whom have specialized expertise in cerebral palsy.

During the spasticity clinic, these experts provide a comprehensive assessment of spasticity and other symptoms. Based on these ongoing evaluations, our experts refer children as needed to the appropriate specialist for treatment.

The spasticity clinic also allows doctors to monitor how a child’s muscles and joints change over time. This surveillance is an important part of treatment, because continued monitoring lets doctors recommend intervention when it best helps a child’s long-term prognosis. For example, if a doctor sees that stiff muscles surrounding the hip may lead to a hip displacement in the future, he or she can recommend medication, rehabilitation, or surgery to help prevent this from happening.

Every child experiences the effects of cerebral palsy differently. For this reason, our doctors individualize treatment based on the results of spasticity assessment. In addition to rehabilitation—which is an important part of any treatment plan—doctors may recommend the following medications or therapies.

Muscle Relaxants

Our doctors may prescribe muscle relaxants to reduce muscle spasticity in children with cerebral palsy. Muscle relaxants may allow your child to become more active and participate in everyday activities more easily.

These medications work by blocking signals that control muscle reflexes in the central nervous system or in nerves within the muscles.

Oral Medication

Medications taken by mouth can ease rigidity in muscles, reduce the severity or frequency of muscle spasms, and control tremors. The doctor determines the correct dosage, depending on your child’s age and the severity of symptoms.

These medications are typically not intended for long-term use and may cause side effects, such as drowsiness and nausea.

Implantable Pump

For children with more severe spasticity, our doctors may recommend a muscle relaxant called baclofen that is administered using a surgically implanted, programmable pump. This treatment is called intrathecal baclofen pump therapy.

The doctor surgically implants the pump, which looks like a small, metal disc, just below the skin of your child’s abdomen. This procedure is performed using general anesthesia.

The pump is attached to a thin tube that carries medicine to the fluid-filled space surrounding the spinal cord, called the intrathecal space. From there, the medication flows throughout the body via the nervous system.

Doctors program the electronic pump to deliver a dose of medication determined to be the most appropriate to relieve your child’s symptoms.

As part of our weekly spasticity clinic, our doctors provide educational resources for children and their families who are considering this therapy. Our experts can also answer any questions children and parents have about a pump that has already been implanted.

Our doctors and nurse practitioners can adjust the medication dose or refill the baclofen pump. Refills may be needed every six weeks to six months, depending on the dose. These adjustments and refills can be done without additional surgery.

Injectable Medication

Doctors may use an injectable muscle relaxant called botulinum toxin, also known as Botox, to reduce muscle spasticity. When injected into stiff or tight muscles, Botox can provide immediate relief from spasticity for as long as three months.

These injections are available in the doctor’s office. Our doctors apply a topical anesthetic spray to make them almost painless.

Botox treatment is typically used on one muscle group at a time. Side effects may include soreness or bruising at the injection site. If Botox injections help your child move more easily, doctors may recommend injections every three or four months.

Our physical and occupational therapists typically recommend serial casting, bracing, and rehabilitation following an injection to maximize its effectiveness. These therapies help to condition your child’s muscles while they are relaxed, which may result in reduced spasticity for a longer period.

Medication to Reduce Drooling

Children whose cerebral palsy affects muscles in the mouth, jaw, and tongue often experience uncontrolled drooling. Excessive drooling may lead to chapped or sore skin around the lips, mouth infections, and dehydration. Uncontrolled drooling may also lower a child’s self-esteem.

Doctors may recommend medication to decrease the amount of saliva the body produces. Some medications can be taken by mouth, and others are available as a small adhesive patch placed behind your child’s ear.

Serial Casting

Serial casting is a noninvasive method of treating mild tendon contractures, which can prevent a child from easily bending or extending a body part such as the foot or arm.

For example, if the Achilles tendon—located at the back of the foot—becomes too tight to allow proper positioning of the foot when standing or walking, your child’s doctor may recommend a series of short plaster leg casts. They gradually stretch the tendon and improve the range of motion in the ankle.

To perform serial casting, a doctor gently stretches the stiff tendon, moving the affected body part into a slightly corrected position. He or she then applies a hard cast that remains on for 7 to 10 days. Your child’s doctor determines how long the cast is worn; most children wear the cast for two weeks.

After two weeks, the cast is removed, and the process is repeated. Little by little, the tendon is stretched, and the joint’s range of motion is increased. After three or four months—or approximately six to eight casts—many children are able to use the affected body part more easily.

Serial casting is often very effective and can prevent the need for orthopedic surgery. However, successful treatment requires the commitment of parents to partner with doctors.

Casting needs to be performed with regularity until treatment is complete, and doctors may also prescribe physical therapy or nighttime bracing after the casting process has ended. This helps retain the effects of casting and may further improve range of motion.