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Ask the Expert: Spasticity After TBI Increased Muscle Spasticity After Traumatic Brain Injury

Brian D. Greenwald, MD


I'm a case manager and have gotten questions from patients and their families about TBI and spasticity — like how often is spasticity a problem and how is it best to treat spasticity that follows a TBI? I haven't been able to find any definitive research. Any ideas?

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Before we talk about the treatment of spasticity, I think we should talk about what is spasticity. So, after a central nervous system injury, an injury to either the brain or the spinal cord, we see--it's not unusual to see an increase in tone, an increase in resistance of the muscles as you try to move them. The severity of this problem can be from mild to severe, so the treatment of it then varies also depending on the severity of the problem. The problem can be seen in actually any of the muscles throughout the body starting from the tongue right straight down to the ankles and the feet. And so again you're looking at the treatment of the problem dependent on where the problem is and the severity of the problem. There is a variety of treatments that you can use for spasticity. Generally treatment is started by doing range of motion and stretching and bracing--usually the early treatments for spasticity. If that's not effective, there are a number of medications that can be used. Medications are generally helpful for mild to moderate spasticity and are often not as effective with more severe spasticity. In more severe spasticity, botulinum toxin injections can be useful, and in even more severe spasticity from there baclofen pumps are sometimes considered where actually a pump is implanted into the person that sends baclofen, a spasticity medication, a fluid, into their spine itself to help relax the muscles. After traumatic brain injury, spasticity is found in about 25% of the patients early on and in about 10% of the patients later on in the community. Early on, when people have spasticity it can be a transient thing that we see in patients after brain injury, and spasticity plays a small role later on. There are a group of patients, as I say, about 10% of the patients who have ongoing needs for treatment of their spasticity. And usually it's a combination of physical therapy techniques, stretching, injections, medications, and sometimes this baclofen pump that we were talking about in more severe cases.

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Brian D. Greenwald, MD Brian D. Greenwald, MD, Dr. Brian Greenwald is medical director of Center for Head Injuries and the associate medical director of JFK Johnson Rehabilitation Institute. He is a clinical associate professor in the Department of Physical Medicine and Rehabilitation at UMDNJ-Robert Wood Johnson Medical School.

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