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Rachael Hutchinson, Consultant Paediatric Orthopaedic Surgeon Norfolk and Norwich University Hospital NHS Trust, Norfolk, UK,
H. Kerr Graham, Professor of Orthopaedic Surgery Royal Children's Hospital, Melbourne, Australia
Spasticity in children continues to be a common and challenging problem for the foreseeable future. While reduction in the incidence of cerebral palsy would have the most impact in reducing the overall incidence of spasticity in children, prevention of traumatic brain injury and spinal cord injury is probably more realistic. Fixed musculoskeletal pathology in cerebral palsy is acquired during childhood. Children with cerebral palsy do not have contractures, dislocated hips or scoliosis at birth. These common deformities are acquired during childhood. There are few useful clinical measures of spasticity and none validated for use in children. The Ashworth and modified Ashworth scales are blunt and unresponsive tools in the assessment of the child with cerebral palsy. Botulinum toxin A (BoNT-A) is a reversible, focal agent which has been under evaluation since the early 1990s in the management of spasticity in children.