Spasticity

• Consider additional diagnostics (MRI cerebrum or myeloma) depending on the situation and condition of the child.

 DO

• Investigate whether there is a cause for increase in spasticity. Treat and (re)assess (after 24 hours) any infection, bladder retention, constipation or non-optimal sitting/lying position.

 DO

• Advise the child on optimal supported posture (in standing, sitting and lying down) to promote the child's movement and performance of daily activities and prevent complications of spasticity.

• Consider using assistive devices and orthoses/ splints to prevent complications due to spasticity and to support movement.
• Consider referral to a physical therapist, occupational therapist or rehabilitation physician for treatment and advice focused on (coping with the limitations due to) spasticity.

 DO

• Consult with a paediatric neurologist or paediatric rehabilitation physician for drug options for treatment of spasticity.

• Consider treatment with baclofen (oral) or in combination with Tizanidine.
• Consider an intrathecal baclofen pump.

 DO

• Consult with paediatric neurologist or paediatric rehabilitation physician for medication options for treatment of spasticity.

• For acute painful muscle spasms, consider diazepam.
• Consider midazolam when there is a need for sedation or treatment of epilepsy.

• In cases of localized spasticity, consider botulinum toxin type A injection in consultation with the rehabilitation physician.

 DO

• Evaluate the effect and side effects of the treatment instituted at the appropriate time, and adjust treatment as needed. Involve child and family in this process.