Spasticity and Contractures in Cerebral Palsy

Children who have cerebral palsy often have high muscle tone. Muscle tone is the amount of tension in a muscle at rest. When muscle tone is higher than usual, it is known as hypertonia. Spasticity and dystonia are the two types of hypertonia most often associated with cerebral palsy.

Long term, spasticity and hypertonia may lead to contractures. Contractures happen when muscles, ligaments, and tendons become tight or shortened due to the repetitive or restrictive movements spasticity and hypertonia can cause. This can make joints stiff and limit how much a child can move.

Many children with cerebral palsy also have spasticity and contractures. Learn more about each of these conditions and how Gillette Children’s can help.

Hypertonia is a general term for muscle tone that is higher than usual. Hypertonia can be caused by a brain injury, such as hypoxic ischemic encephalopathy (HIE). This injury can happen before, during, or after birth. Some children who have HIE are later diagnosed with cerebral palsy.

Hypertonia may also be caused by:

• An infection
• Stroke
• Trauma
• Premature birth
• Certain genetic conditions

The level, or severity, of hypertonia, is usually related to the level of brain injury: children with more severe neurological problems often have more severe hypertonia.

There are many types of hypertonia, but the two most common forms in children are spasticity and dystonia. Most children who have cerebral palsy experience some degree of both spasticity and dystonia. 

Spasticity is a form of hypertonia that is usually constant. Someone who experiences spasticity may feel that their muscles are tight or locked in one position.

Spasticity happens when signals between the brain, spinal cord, and muscles do not work in coordination. Messages from the muscles may not reach the brain, or signals from the brain may not reach the muscles to tell them to relax. Spasticity can be mild to severe.

Dystonia can also cause higher muscle tone, but it is not constant—it comes and goes. Dystonia can affect one area of the body (focal dystonia) or the entire body (general dystonia). 

Contractures happen when muscles, ligaments, and tendons become tight or shortened. This tightening or shortening can cause limited range of motion and joint stiffness due to changes to the structure of muscles, ligaments, and tendons.

Contractures may be caused by prolonged spasticity, burns, or trauma to the affected area. In children with cerebral palsy, contractures usually happen because their movement is limited or restricted.

Contractures often worsen during growth spurts, especially in the teen years. If children who have cerebral palsy lose skills during these growth spurts, it can be difficult to gain them back.

Treatment for reduced range of motion to prevent contractures from forming may include:  

• Stretching exercises
• Bracing
• Surgery 

Spasticity and contractures in children who have cerebral palsy can be treated in a variety of ways, including:

• Oral medications
• Placement of an intrathecal baclofen pump, which gives a steady low dose of medicine to reduce spasticity
• Physical therapy
• Surgeries such as selective dorsal rhizotomy, which cuts certain nerve fibers in the spinal cord to reduce spasticity

Contractures, once formed, can only be treated with surgery.

Spasticity management is a key component of coordinated cerebral palsy treatment at Gillette Children’s. We offer a specialized spasticity evaluation for children, wherein a multidisciplinary team of our experts evaluates your child's spasticity with several tests and designs a care plan tailored to each child's unique needs.

Our care teams include board-certified experts in pediatric physical medicine and rehabilitation, orthopedics, and neurosurgery, in addition to physical and occupational therapists. The Gillette Children's Cerebral Palsy Institute is dedicated to research, advocacy, and clinical excellence in the care and treatment of cerebral palsy. When you come to Gillette, our entire team is available to support you and your child throughout their journey.

Do you need assistance navigating care for your child's spasticity? Request a spasticity evaluation with our experts.