Here's a look at who may develop spasticity

Early, proactive case management is essential to cost-effective disability management. If case managers understand which patients typically develop spasticity problems, they can intervene before spasticity leads to significant losses in function and range of motion.

"Any patient with a condition affecting the central nervous system, or an injury to the brain or spinal cord, has the potential to develop spasticity, and case managers should be on the alert for losses in function or range of motion in those patients," notes Alan M. Harben, MD, assistant professor of physical medicine and rehabilitation with The Emory Clinic in Atlanta.

In general, different patient populations present with different patterns or types of spasticity problems, he explains. Those include:

Brain injury patients.

"Brain injury patients can develop unilateral or bilateral spasticity, depending on the injury. They typically develop extensor spasticity and posturing in the early stages post-injury. Early intervention can help patients maintain maximum range of motion and limit functional losses," he says, adding that brain injury patients should be evaluated for spasticity and range-of-motion issues within two weeks of injury, while still in acute rehabilitation.

"Even patients who are in a vegetative state can benefit from intervention," says Harben. "Patients can remain in a vegetative state for as long as two years and become so contracted that they are spoiled for future rehabilitation opportunities," he notes. "These patients benefit from therapy to maintain range of motion. This can be done with alcohol blocks to major nerve groups."

Spinal cord patients.

"Spinal cord patients often develop spasticity that is more sensitive to cutaneous stimulation. For example, their spasticity may be triggered when they hit a bump in their wheelchair," he explains. "This type of spasticity makes it difficult for patients to sit in their chair or drive a car safely," he adds.

"Spinal cord patients respond well to nerve blocks to major muscle groups. A set of blocks can provide six to nine months of relief for a spinal cord patient and allow the patient to resume activities such as safe driving," Harben says.

Stroke patients.

Stroke patients often develop flexor spasticity in the upper body and tremor in the lower body, says Harben. "These problems often develop six to 12 weeks post-stroke and can last until six to 12 months post-stroke, he notes. "Aggressive intervention should not begin until six weeks or later post-stroke, and before any interventions are made there should be a functional goal in mind," he cautions. (For a discussion of setting functional goals in spasticity management, see the cover story.)