Spasticity and Movement Disorders Clinic
As part of Nicklaus Children’s Hospital’s Brain Institute, the Spasticity and Movement Disorders Program provides a multidisciplinary approach, treating movement conditions and disorders, including cerebral palsy. The program strives to treat and prevent mechanically unbalanced joints in children with spasticity to improve functional performance and foster a more independent lifestyle.
- Spasticity: stiffness of muscles or resistance to stretching that interferes with normal movement.
- Dystonia: abnormal body movements or postures such as twisting that interfere with normal movement and coordination.
These conditions occur as a result of any damage within the central nervous system that impairs the coordination of muscle activity. It is most commonly related to:
The Importance of a Team Approach to Care
During clinic visits, patients are seen by specialists in neurology, neurosurgery, orthopedics, physiatry and physical/occupational therapy. Specialists meet after each clinic and discuss every case individually. The clinical coordinator reaches out to the family to review treatment recommendations and schedule specific interventions. Meet the Team.
Treatment Options for Spasticity
The Spasticity and Movement Disorders Clinic offers a variety of treatments options to manage spasticity. Treatments options are individualized to each patient depending on the cause of the condition, age, general health and nutritional status as well as goals of treatment.
Treatments for Dystonia
- For dystonia, we offer oral medications, Botox injections and placement of a deep brain stimulator, an implantable device that sends electrical impulses to help with the management of movement and other neurological disorders. Patients may also need orthopedic surgery to correct bone deformities or lengthen tendons.
Baclofen Pump Insertion and Therapy
- Intrathecal Baclofen pump therapy consists of the administration of continuous intrathecal Baclofen via an implanted, programmable pump. Refills of the baclofen medication are required at regular intervals based on the individual patient’s needs to ensure a continuous supply of the medication. This treatment can be a good option for patients whose arms are more affected than their legs, or have a combination of spasticity and other movement disorders such as dystonia.
Selective Dorsal Rhizotomy
- Another treatment option to relieve spasticity. The sensory nerve bundles that are the most abnormal are selectively cut to help alleviate the spasticity. This can help patients who walk using assistive devices to improve walking ability. It can also be considered for other patients who have significant pain related to their spasticity as a “palliative” option. Patients need intensive rehabilitation after the surgery to achieve the best outcomes.
Deep Brain Stimulation
- Deep Brain Stimulation (DBS) is an option for patients who suffer from movement disorders such as dystonia. It is a neurosurgical procedure involving the implantation of a “brain pacemaker” that sends electrical impulses, via implanted electrodes to specific parts of the brain for treatment of movement disorders.
Use of iMRI
Nicklaus Children’s Hospital is the first pediatric facility in Florida to acquire intraoperative magnetic resonance imaging (iMRI) leading-edge equipment, which brings MRI technology – recognized as the “gold standard” in differentiating between healthy and abnormal brain tissue – directly into the surgical suite to enhance safety and ensure complete removal of tumors and preservation of healthy tissue.
Selective Dorsal Rhizotomy/Baclofen Pump
A common characteristic of various neurological disorders is spasticity, which is the excessive tightness or tension of certain muscle groups. It interferes with smooth, coordinated motions, and results in limited movement patterns and impaired motor skills. Selective dorsal rhizotomy (SDR) and the Baclofen pump are two treatments for spasticity that may help reduce muscle tension.
SDR is a spasticity treatment that reduces spasticity in the lower extremities. Through this procedure, certain hyperactive sensory rootlets coming from the muscles are cut. Interrupting these abnormal pathways from the muscle reduces abnormal sensory input. Selective dorsal rhizotomy strives to restore balance between the sensory information and the motor responses.
An SDR team evaluates children being considered for surgical treatment, via a selective dorsal rhizotomy or the Baclofen (a drug that reduces spasticity) pump. The Baclofen pump is surgically implanted under the abdominal skin with a catheter inserted into the spinal canal and requires regular maintenance.
Children able to walk alone or with braces, walker, or crutches may be videotaped. Each team member will examine the child. The group will then meet to discuss which procedure will be in the child's best interest. The surgeon will discuss with the family the risks and the potential benefits and if surgery is scheduled, the clinical nurse specialist will assist in obtaining equipment and coordinating therapies.
While neither of these spasticity treatments - selective dorsal rhizotomy or the Baclofen pump - will eliminate the underlying neurological problem (e.g. Cerebral palsy), reducing the spasticity may allow better muscle control and function. Therapy will also be essential before and after surgery.