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This chapter reviews the pathophysiology of spasticity, and outlines the rationale for treatment and the development of treatment goals. Lesions of the brain and spinal cord that interfere with the descending motor pathways often result in spasticity. A number of neurotransmitters are involved in the sensory and motor pathways that regulate muscle tone. Spasticity can be evaluated at bedside during the physical examination. It can be more formally assessed using quantitative scales and laboratory measures. Orthotic devices are considered in the management of spasticity, to reduce tone, improve range of motion, prevent contractures, and reduce pain. Treatment for spasticity is generally initiated when the increase in muscle tone interferes with functional activities. The chapter discusses the pharmacologic and surgical management strategies. For focal spasticity, treatment with botulinum toxin or nerve blocks may of benefit. For severe refractory cases of spasticity neurosurgical procedures can be considered.
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