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- triplegia 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%

 

Hospitalization and surgical procedures= $20,000-

25,000

Intensive PT during first year   = $10,000-

$25,000

Spastic     quadriplegia; not capable of ADLs

Severe leg spasticity; interferes    with care

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

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