What are the recommended strategies for managing spasticity in children with cerebral palsy?

Recommended strategies for managing spasticity in children with cerebral palsy include:

• Access to a multidisciplinary network team: Children should have timely referral to a team with expertise in paediatrics, nursing, physiotherapy, occupational therapy, orthotics, orthopaedic surgery, neurosurgery, and paediatric neurology to ensure integrated care and effective management ¹.
• Individualised, goal-focused management programmes: These should be developed in partnership with the child and their parents or carers, taking into account the child’s developmental potential and family impact, with goals that are age-appropriate and cover body functions, activities, participation, and environmental factors ¹.
• Physical therapy: Tailored physiotherapy and occupational therapy programmes aimed at enhancing skill development, function, participation, and preventing complications such as pain or contractures should be offered promptly ¹.
• Orthotic management: Use of orthoses such as elbow gaiters, wrist orthoses, ankle–foot orthoses, and body trunk orthoses can help maintain joint position, improve function, prevent contractures, and assist with posture and gait. Orthoses should be regularly reviewed for fit, comfort, and effectiveness ¹.
• Oral medications: Consider oral diazepam for rapid relief of spasticity-related discomfort or muscle spasms, and oral baclofen for sustained long-term management. Dosages should be carefully titrated and reviewed regularly, with consideration of combined therapy if monotherapy is insufficient ¹.
• Botulinum toxin type A injections: These are recommended for focal spasticity, such as dynamic equinus foot deformity in ambulant children aged 2 years and older, and should be administered by specialists within the network team ¹.
• Monitoring and ongoing assessment: Regular monitoring of treatment response, spasticity progression, secondary complications (e.g., pain, contractures, hip displacement), and adjustment of goals is essential ¹.
• Support and education: Provide age-appropriate information and support to children and families, including access to patient organisations and equipment necessary for management (e.g., postural supports) ¹.

These strategies align with the broader multidisciplinary care approach recommended for children with cerebral palsy, emphasizing coordinated care, early identification of associated problems, and specialist referrals as needed ².