Spasticity
Spasticity is the term used to describe increased tone in the muscles of the body, which happens as a consequence of various neurological conditions including stroke. The Wikipedia definition can be found here: en.wikipedia.org/wiki/Spasticity
Spasticity can be painful and lead to contractures with secondary skin and soft tissue damage. Principles of management include: Early detection, referral for therapy assessment, and where required, referral for specialist review in the Spasticity Clinic.
UHL Spasticity Clinic
Clinics are held at the Leicester General Hospital, and are provided by either the Stroke Service or Neuro-Rehabilitation Service. Each clinic is run by a Specialist Doctor and Specialist Physiotherapist, with interest in management of spasticity.
Referrals to the Stroke Spasticity Clinic
Patients suffering with post-stroke spasticity should be referred initially to Community Physiotherapy and/or Occupational Therapy for review and initial management. This may include exercises, stretching, limb positioning, and splinting, as appropriate.
If specialist spasticity review is required, referrals can be made to Dr Naeem Hassan- (Stroke Associate Specialist). Please send a referral letter to Dr Hassan stating the patients' details, medication, past medical history and nature of their current spasticity.
Referrals to the Neuro Rehabilitation Spasticity Clinic
Patients suffering with spasticity from other conditions, other than stroke, should initially be referred to Community Physiotherapy and/or Occupational Therapy for review and initial management. This may include exercises, stretching, limb positioning, and splinting, as appropriate.
If specialist spasticity review is required, referrals can be made to Dr Prasad (Neuro Rehab Consultant) or via the Spasticity Mailbox ( uhl-tr.spasticityclinic@nhs.net ). Please send a letter to Dr Prasad or to the Mailbox stating the patients' details, medication, past medical history and nature of their current spasticity.
Clinic appointment
If you are appropriate for review in Spasticity Clinic, you will be sent an appointment date and time from the Clinic Coordinator team.
At the Clinic, you will be assessed by a Specialist Consultant and Specialist Physiotherapist who will look at your movements, strength and functional abilities. They will make a decision as to how best to treat your spasticity. Options may include:
- advice about stretches or positioning
- referrals to community based physiotherapists / Occupational therapists
- advice about oral medications that may help e.g. Baclofen / Tizanadine.
- injections of Botulinum toxin into the affected muscles
- referrals for other treatment options including surgery, Functional electrical stimulation, splints, wheelchairs.
Depending on the choice of treatments, you may be offered further follow up appointments in the Spasticity Clinic to review your progress.
For reference: Royal College of Physicians Guideline: Spasticity in Adults
www.rcplondon.ac.uk/publications/spasticity-adults-management-using-botulinum-toxin
