A Quick Guide to Abnormal Movement in Cerebral Palsy
Individuals with cerebral palsy may experience two common muscular issues: hypertonia and contractures. Both of these issues can be troublesome and impede functioning, yet their underlying causes my differ and therefore, necessitate different treatment.
Hypertonia and Spasticity
Hypertonia is a generic term that encompasses all abnormal increases in muscle tone. Hypertonia can be caused by an injury like hypoxic ischemic encephalopathy or dysmorphia in the central nervous system—for example, schizencephaly. Infectious encephalopathies, stroke, trauma, premature birth, and genetic disorders can also cause hypertonia.
There are many types of hypertonia, but the two most common forms in children are spasticity and dystonia. Most children with cerebral palsy have both, with varying severity of each. In general, the severity of hypertonia is proportional to the severity of neurological impairment.
Spasticity is a motor disorder caused by an upper motor neuron lesion and characterized by a velocity-dependent increase in tonic stretch reflexes. In clinic, this results in increased muscle tone, enhanced tendon reflexes, clonus, and re-emergence of primitive reflexes.
Contractures refer to the tightening or shortening of muscles, ligaments, and tendons, which can lead to joint stiffness and limited range of motion. The loss of joint mobility is caused by structural changes in non-bony tissue.
Contractures can be caused by muscle imbalance, prolonged spasticity, burns, and local trauma, but most often we see contractures being the result of immobilization.
Contractures often worsen as a child goes through a growth spurt, especially during their pubescent growth spurt in adolescence. Often, the skills that are lost during this time can be very difficult to regain. Contractures may be managed with stretching exercises, bracing, and surgical intervention.
Why Treat Spasticity?
Not all spasticity needs to be treated. If spasticity interferes with your patient’s daily activities, restricts joint movements, or poses challenges for caregivers, a spasticity evaluation at Gillette can help determine a custom treatment plan.
A patient may experience many benefits from spasticity treatment, including:
• Reduced risk of contractures
• Ability to achieve developmental milestones
• Easier time performing daily care tasks
• Better positioning and comfort
• Improved function
• Increased tolerance of braces
• Minimized long-term impact of neurological impairments
How Gillette Children's Can Help
Management of spasticity requires a multidisciplinary approach and consideration of various treatment options. At Gillette, we work closely with the primary care provider and the patient family to develop a plan for treating spasticity that considers the patient’s age, severity of spasticity, functional ability, and individual goals.
Gillette offers all avenues of treating spasticity, including physical therapy and rehabilitation, oral medications, intrathecal baclofen pump, and selective dorsal rhizotomy.