Treatment should be based on assessment by relevant health professionals. For spastic muscles with mild-to-moderate impairment, exercise should be the mainstay of management, and is likely needed to be prescribed by a Physiatrist (Doctor specialized in Rehabilitation medicine), occupational therapist, physical therapist, accredited exercise physiologist (AEP) or other health professional skilled in neurological rehabilitation. Muscles with severe<unk>  are likely to be more limited in their ability to exercise, and may require help to do this. In spastic cerebral palsy children the main treatment modality of<unk>  is conservative in the form of botulinum toxin A injection and various physical therapy modalities such as serial casting, sustained stretching and medical pharmacologic treatment.<unk>  in cerebral palsy children is usually generalized although with varying degrees of severity across the affected extremities and trunk musculature. Neglected or inappropriately treated<unk>  can eventually lead to joint contractures. Both<unk>  and contractures can cause joint subluxations or dislocations and severe gait difficulties. In the event of contracture there is no role for conservative treatment. Hip dislocation and ankle equinus deformity are known to arise from muscle<unk>  primarily. Orthopedic surgical reconstruction of the hip is commonly practiced to improve sitting balance, nursing care and relief hip pain. Treatment should be done with firm and constant manual contact positioned over nonspastic areas to avoid stimulating the spastic muscle(s). Alternatively, rehabilitation robotics can be used to provide high volumes of passive or assisted movement, depending on the individual's requirements; this form of therapy can be useful if therapists are at a premium, and has been found effective at reducing<unk>  in patients suffering from stroke. For muscles that lack any volitional control, such as after complete spinal cord injury, exercise may be assisted, and may require equipment, such as using a standing frame to sustain a standing position. A general treatment guideline can be followed that involves: * The initial focus on first activating contraction of antagonist muscles to provide reciprocal inhibition and lengthen spastic muscles * Reciprocal actions are attempted. Agonist contractions are performed first in small ranges progressing to larger arcs of movement * Highly stressful activities be minimized early in training * Functional skills are targeted for training * Patients and family/caregivers should be educated about the importance of maintaining range of motion and doing daily exercises Medical interventions may include such medications as baclofen, diazepam, dantrolene, or clonazepam. Phenol injections can be used, or botulinum toxin injections into the muscle belly, to attempt to dampen the signals between nerve and muscle. The effectiveness of medications vary between individuals, and vary based on location of the upper motor neuron lesion (in the brain or the spinal cord). Medications are commonly used for spastic movement disorders, but research has not shown functional benefit for some drugs. Some studies have shown that medications have been effective in decreasing<unk> , but that this has not been accompanied by functional benefits. Surgery could be required for a tendon release in the case of a severe muscle imbalance leading to contracture. In spastic CP, selective dorsal rhizotomy has also been used to decrease muscle overactivity. Incorporating hydrotherapy in the treatment program may help decrease spasm severity, promote functional independence, improve motor recovery and decrease medication required for<unk> , which may help reduce the side effects that are possible with oral drug treatments. A 2004 study compared the effects of hydrotherapy on<unk> , oral baclofen dosage and Functional Independence Measure (FIM) scores of patients with a spinal cord injury (SCI). It was found that subjects who received hydrotherapy treatment obtained increased FIM scores and a decreased intake of oral baclofen medication. A 2009 study looked at the effect of hydrotherapy to decrease<unk>  on post-stroke, hemiparetic patients with limited mobility and concluded that there was a significantly larger increase in FIM scores compared to the control group that did not receive hydrotherapy.
Spasticity
Hypoalgesia
Hyperalgesia
Decompensation
Abnormal posturing
Paresis
Spasm
Tickling