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Elly Hammerman Spasticity Center The Spasticity Center of The Center for Children offers a comprehensive medical setting for the evaluation and treatment of spasticity in children and
young adults. Spasticity is an abnormal response of muscle that results in contractures (when the hips, knees, ankles, shoulders, elbows and wrists become so tight that they no longer
bend or straighten). The most effective way to treat spasticity is through a multi-disciplinary approach, which consists of participation from many different medical specialties. The following medical
specialists comprise the Spasticity Center's health care team:
- Pediatric Rehabilitation Medicine
- Pediatric Orthopaedic Surgery
- Pediatric Neurosurgery
- Pediatrics
- Physical Therapy
- Occupational Therapy
- Nursing
- Social Work
Upon a child's first visit to the Spasticity Center, each member of the health care team examines the patient. The team then consults with each other and develops a care plan that is tailored to each
child's specific condition. After the child's initial evaluation, the patient's progress will continue to be monitored by the Center. Because the severity of spasticity differs for each child, the
Spasticity Center offers several treatment options
ranging from non-invasive to surgical intervention. They include:
Heat
ROM/Stretching
E-Stim
Serial Casting
Orthotics
Splinting
Oral Medications
Nerve and Motor Point Blocks
Selective dorsal rhizotomy
Intrathecal Baclofen therapy
(Baclofen pump)
Orthopaedic surgery
To schedule an appointment or to obtain additional information, please contact
(212) 598-2330 or email us at centerforchildren@hjd.org Treatment Options: Heat: moist heat application is used prior to muscle stretching to improve elasticity of muscle fibers.ROM/Stretching:
to improve the integrity of joints and muscle flexibility and to allow for better alignment and positioning. E-Stim: an innovative method of treatment used
by applying electrical stimulation to atrophied muscle fibers resulting in improved performance of muscle activity. Serial Casting: the repeated
application of plaster or fiberglass casts to gradually increase and restore functional soft tissue extensibility and delay or prevent the need for surgery. This method is often used following treatment of BOTOX
injections of the foot and ankle. Orthotics: custom molded lower limb positioning device designed to improve function and preserve range of motion.
Fabricated from a variety of plastic material these orthotics are commonly worn during day or nighttime hours. Splinting:
the fabrication of splints to provide a prolonged muscle stretch, preserve range of motion and stability of joints as needed to improve the overall functional use of extremities. Oral Medication: various oral medications are being used to decrease spasticity, which are customarily monitored by a neurologist. Drugs such as Baclofen or
Tizanidine, have the effect of causing sedation and have had varying degrees of effectiveness. These medications are often the first line of treatment for spasticity. However, these oral medications are not
for some children. Nerve and Motor Point Blocks: nerve blocks decrease muscle tone
(tightness of muscles) and have been quite successful in the past. Blocks are used to loosen muscle in a patient who has improving spasticity, is a very young child or for a specific muscle that is causing trouble. A physiatrist, neurologist or orthopaedic surgeon often administers these drugs with an injection directly into the muscle. Botox, phenol or alcohol are the most commonly used drugs but no one drug has proven to be more effective than the other. The effect of the nerve block usually lasts 3-6 months. If the block is effective in decreasing tightness, but the problem returns, a
selective neurectomy
can be performed by the orthopaedist or neurosurgeon to permanently reproduce the effect of the block. Rhizotomy: a rhizotomy is a spinal operation
performed by a pediatric neurosurgeon which effectively decreases spasticity in the
lower extremities. The surgery involves sectioning the dorsal nerve roots that are abnormal and involved in the spasticity. It requires
extensive physical therapy after surgery.Baclofen pump: this is a relatively new treatment option for spasticity. The baclofen pump infuses continuous
medication, on a 24 hour basis, into the spinal canal of a child. The pump, roughly the size of a hockey puck, is inserted by the neurosurgeon and is placed under the skin in the abdomen of the child. The
pump needs to be refilled in the office approximately every 8-12 weeks. The pump has been shown to effectively reduce overall spasticity and dystonia
(involuntary motions of the upper and lower extremities) in patients. The pump requires intensive follow-up and frequent visits to the office for a medication refill for as long as the pump is in place. The pump cannot treat
fixed contractures.Orthopaedic Surgery: the orthopaedic surgeon deals mainly with mechanical malalignment. If the hip is dislocated, the leg is twisted or the spine is severely
curved these will often require surgical intervention. Common procedures performed on children with spasticity include:
- Tendon transfers
- Osteotomies
- Fusion
- Open reduction
- Tendon Lengthening
To schedule an appointment or to obtain additional information, please contact
(212) 598-2330 or email us at centerforchildren@hjd.org |
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