Spasticity Management in Neurological Disorders

Spasticity is a common consequence of upper motor neuron lesions such as stroke, cerebral palsy and multiple sclerosis, characterised by a velocity-dependent increase in muscle tone and hyperexcitability of spinal reflex pathways. It emerges from an imbalance of excitatory and inhibitory inputs to spinal circuits, compounded by secondary changes in muscle and connective tissue. Effective management requires accurate assessment, targeted interventions to reduce neural hyperactivity and prevention of contracture and pain. Clinical strategies range from physical therapies to pharmacological agents and focal treatments such as botulinum toxin injections. Recent advances in quantitative modelling have enhanced the ability to distinguish neural from non-neural contributors to resistance, facilitating personalised rehabilitation plans. Concurrently, novel non-invasive techniques aim to modulate tissue properties and reflex excitability, while an improved understanding of neural plasticity underpins early, goal-oriented therapy to harness adaptive reorganisation. Integrative care that addresses the biomechanical, neurophysiological and functional dimensions remains central to improving mobility, independence and quality of life for individuals with spasticity.

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Spasticity Management in Neurological Disorders publication trend

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Technical terms

Spasticity: A velocity-dependent increase in muscle tone due to exaggerated stretch reflexes.

Upper motor neuron syndrome: A set of motor impairments resulting from lesions of descending pathways above the spinal motor neurons.

Neuromechanical model: A computational framework that integrates neural control and mechanical properties of muscles and joints to predict movement behaviour.

Extracorporeal shockwave therapy: A non-invasive treatment using high-energy acoustic waves to alter muscle and connective tissue properties and modulate reflex excitability.

Neural plasticity: The capacity of the nervous system to reorganise its structure and function in response to experience, learning or injury.

Modified Ashworth Scale: A clinical ordinal scale for grading resistance to passive movement, commonly used to assess spasticity severity.

References

1. Identification of Neural and Non-Neural Origins of Joint Hyper-Resistance Based on a Novel Neuromechanical Model. IEEE Transactions on Neural Systems and Rehabilitation Engineering (2024).
2. The dose effectiveness of extracorporeal shockwave on plantar flexor spasticity of ankle in stroke patients: a randomized controlled trial. Journal of NeuroEngineering and Rehabilitation (2024).
3. Spasticity, Motor Recovery, and Neural Plasticity after Stroke. Frontiers in Neurology (2017).