Spasticity Diagnosis and Management.

Spasticity: Diagnosis and Management is the first
book solely dedicated to the diagnosis and treatment
of spasticity. Arguably, this text could have been titled
Upper Motor Neuron Syndrome, as spasticity is just
one of many components of the constellation of conditions that make up the upper motor neuron syndrome
(UMNS). Other authors use the phrase “muscle overactivity” to describe these conditions, but since the
term most commonly used by physicians, therapists,
patients, and caregivers is spasticity, we chose this as
our title while the actual focus of the book is about
the broader context of UMNS and how it leads to disability.
Spasticity is only part of the UMNS as is so eloquently described by Dr Mayer in Chapter 3. UMNS
occurs when damage to the brain or spinal cord results in a constellation of signs and symptoms that
may include spasticity or increase in tone, rigidity,
and flexor spasms superimposed on any combination
of weakness, paralysis, and/or decreased dexterity.
The varied clinical characteristics of UMNS must be
taken into account when developing a treatment plan.
In Chapter 8, Dr Elovic discusses the importance of
evaluating the patient, their support systems, and the
clinical manifestation of the UMNS so that clinicians
can set realistic and obtainable treatment goals. The
editors’ objective in the development of this book
were to clearly define the process for the diagnosis of
spasticity, the basic science behind its pathophysiology, the measurement tools used for evaluation, and
the available treatment options.

Part III of the text focuses on treatment and outlines the many tools available to physicians such as
oral medication, intrathecal baclofen, and chemodenervation in Chapters 9 through 11. Chapters 10 and
11 are specifically dedicated to the use of botulinum
toxin in adults, with in-depth coverage of chemodenervation treatment protocols for upper and lower
extremity spasticity. Drs Truong and Pathak provide
a detailed artistic rendering in Chapter 12 of the important muscles and landmarks in spasticity management. Chapter 13 focuses on nonmedical therapeutic
modalities and highlights the role of therapists as an
important part of the management team. Dr Flanagan’s discussion of the role of the emerging technologies in Chapter 14 highlights the continued evaluation
of the treatment of spasticity for patients. In Chapters
15 and 16, Drs Meythaler and Saulino, discuss the
role of oral medication and more invasive treatments
such as intrathecal baclofen. In Chapter 17, Dr Fuller discusses the important and often overlooked option
of neuro-orthopedic intervention in the management
of spasticity.
Part IV of the book is devoted to the evaluation
and management of individual diseases involving spasticity, which reinforces the importance of disease diagnosis and management in the patient with spasticity
and reemphasizes the need to establish an accurate diagnosis before embarking on treatment. Amyotrophic
lateral sclerosis, multiple sclerosis, poststroke spasticity, traumatic brain injury, and spinocerebellar ataxia
(discussed in Chapters 20–24) are very different conditions, even though each may present with spasticity. Accurate diagnosis is paramount in designing the
appropriate treatment plan for these distinct diseases.
Chapters 25 and 26 are devoted to the unique challenges involved in diagnosing and managing spasticity
in children with detailed discussions of chemodenervation and surgery. Finally, Chapter 27 reviews the
basic science and the role of animal models in better
understanding the underlying mechanisms of spasticity in patients with spinal cord injury.
Until the advent of oral medications, intrathecal baclofen, and botulinum toxin, the treatment of
disorders of tone as part of the UMNS was often
frustrating for the patient, caregiver, and physician.
With the development of effective therapies and a
team approach to management of these disorders, we
have sought to address the diagnosis and treatment of
spasticity in an integrated, clinically useful text. Our
charge was to provide a one-stop resource for physicians, therapists, and other healthcare providers who
serve the complex needs of these patients with the goal
of offering the highest level of care and improving
outcomes.