The Cerebral Palsy Network

Treatment for Spasticity
METHOD	AGE(YEARS)	DIAGNOSIS	CHAR- ACTERISTICS	EXPECTED RESULTS	Follow-up Care	OUTCOME	SIDE EFFECTS; RISK	COST ESTIMATES
ORAL MEDI- CATIONS	Any age most often 2-5 yrs	Spastic quad- riplegia TBI	Diffuse Spasticity	Mild decrease in spasticity in arms and legs	PT/OT as needed	Often need SDR or ITB later	Drowsiness	Medications= $ 40-60 Each month
BOTOX INJECTIONS	Any age: less often over 10	Spastic diplegia; Spastic quadriplegia TBI	Isolated Spasticity Too young for SDR, ITB	Decrease in spasticity injected muscles(s) for 2-4 months	PT,OT, to increase range of motion and to increase strength	Improved gait; sometimes improved arm function	None with usual doses	Procedure: injection(s) $250-$400 Medication each time, cost depends on dosage= $400-800 (Every 3-4 months)
RHIZOTOMY SDR	4-8(most common)	Spastic diplegia or quadriplegia capable of ADLs	Good leg strength; no severe con- tractures; motivation for PT	Marked, permanent, non adjustable decrease in spasticity	Extensive PT/OT	Improved walking;	infection: 2% Wound: 1% Spinal fluid leak: 3%	Hosp- italization and surgical procedures= $20,000- 25,000 Intensive PT during first year = $10,000- $25,000
RHIZOTOMY SDR	4-8(most common)	Spastic quadriplegia; not capable of ADLs	Severe leg spasticity; interferes with care	Marked, permanent, non adjustable decrease in spasticity	Minimal	Improved ADLs; decrease in orthopedic operations Easier care	Infection: 2% Wound: 1% Spinal fluid leak: 3%
BACLOFEN ITB	Over age 3: big enough to insert pump	Spastic quadriplegia; spasticity in legs greater than or equal to spasticity in arms; capable of ADLs	Severe spasticity; positive response to test dose; spasticity limits function	Decrease in spasticity	Frequency of PT,OT depends on goals	Improved walking; improved ADLs; improved speech; decrease in orthopedic operations; easier care	Infection: 5-10% Wound: 5-10% Spinal fluid leaks: 5-10%	Hospital- ization, implant proceedure, pump= $20,000- $25,000 Initial medication= $400 Medication refills (3-5/year)= $200-300 (New pump; repeat hospital- ization and procedure every 4-5 years)
		TBI	Sever Spasticity interferes with care; positive response to test dose; spasticity limits ADLs		Minimal PT	Easier Care
		Spastic quadriplegia; not capable of ADLs			Minimal PT	Easier Care
OT/PT	Any age	Spasticity of any extremity	Spasticity impairs function or reduces range of motion	Increased rage of motion, strength, function	Depends on goals, motivation	Improved function or ease of care, minimize deformity	None	$100- $150 per treatment session
ORTHOPEDIC SURGERY	Any age, most common over 4 years	Hip disloc- ations Muscle/ tendon contractures Bone/joint deformities	Con- tractures Bone Deform- ities	Increased range of motion; improved gait; decreased deformity	PT, depending on goals	Depends on goals	Infection 25%Bony non- unions 25% Re- constructions	$20,000 or more
KEY TO TERMS: PT: Physical Therapy; OT: Occupational Therapy; TBI: Traumatic Brain Injury

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Last updated 03/24/03