Treatment for Spacticity |
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-
riplegia 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 stregth |
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; Improved ADLs;
decrease in orthopedic operations |
infection: 2% Wound: 1%
Spinal fluid leak: 3% |
Hosp- italization 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 |
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 funtion 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 contratures Bone/joint
deformities |
Con- tractures Bone Deform- ities |
Increased range of motion; imporved gait; decreased
deformity |
PT, depending on goals |
Depends on goals |
Infection 25%Bony non- unions
25% Re- constructions |
$20,000 or more |
| KEY TO TERMS: PT: Physical Therapy; OT:
Occupational Therapy; TBI: Traumatic Brain Injury |
