Spasticity is a common symptom seen in people with multiple sclerosis (MS) and can play a major role in disability. Spasticity has important clinical manifestations including tonic increases in muscle tone with limb rigidity and/or a phasic pattern of uncontrolled spasms. Spasticity, with or without muscular weakness, is a cause of loss of function and pain. Secondary complications occur due to impaired mobility. These include contractures, skin ulcerations, and infection. An interdisciplinary approach is an effective way to manage spasticity in people with MS.
Traditionally, managing spasticity has taken a ladder approach. It is presented as a stepwise progression of stretching program, followed by the introduction of anti-spasticity medications (oral or injectable), then intrathecal infusion of Baclofen and finally chemical and surgical destructive procedures. In individuals with MS one must not only evaluate severity of spasticity but its impact on multiple daily physical functions. In some cases spasticity can help with functional movements. For example, someone with increased extensor tone in their legs (tone which allows them to straighten their legs at the knees and hips) may utilize their tone to get from a sitting to standing position. In addition, one must consider the impact of other symptoms on function such as fatigue, tremor, weakness, or cognitive problems. The individuals’ living environment, caregiver, and financial resources must also be taken into consideration. Therefore, multiple interventions, simultaneously, in a carefully constructed plan of treatment and follow-up is more effective. It is difficult for a single care provider to evaluate and devise such a treatment plan due to time constraints and expertise. The advantage of the interdisciplinary approach is the combination of expertise from physicians and allied health care professionals in devising a treatment plan specific to the patient. This approach is designed to devise a plan of treatment to more comprehensively evaluate the individual (in a relatively short period of time) and determine the appropriate intervention. This may include rehabilitation, medication adjustments, injection for Botox or Phenol, intrathecal baclofen or other surgical procedures.
There are different treatment approaches to managing spasticity. An interdisciplinary approach has proven to be a very effective method due to the constraints of time and expertise experienced by a single care provider.
A special thanks to Dr. Karen Theriot for her assistance with this article content. Dr. Theriot is a physiatrist in private practice in Denver, CO. She sees many patients with MS and is a renowned expert in spasticity management.