Spasticity Management

Spasticity Management

We use a new technique called single event multi-level chemoneurolysis (SEMLC) to treat children with cerebral palsy, traumatic brain injury, pediatric stroke, and spinal cord injury. This approach reduces muscle tone and spastic symptoms in a single operation.

Children with cerebral palsy, traumatic brain injury, pediatric stroke, and spinal cord injury often experience pain and struggle to walk. Without treatment, they may develop painful arthritic joints. Some patients may benefit from multiple surgeries on their lower extremities (hips, knees, ankles, and/or feet).

Rather than subject children to several procedures, we use SEMLC to correct all existing soft tissue and bone problems in one operation with just one phase of rehabilitation. To control stiff or spastic muscles, we also use botulinum toxin injections and alcohol motor nerve injections as well as an intrathecal baclofen pump (ITB) in conjunction with neurosurgery to deliver medication directly to the spinal cord.

Our approach treats a larger number of stiff muscles and succeeds at decreasing pain and delaying orthopedic surgeries, while also improving and maintaining a child’s ability to function.

Our physiatrists help parents and children decide on a treatment plan based on progression of the disease. In our interdisciplinary spasticity clinic, we identify appropriate types of therapy from a menu of surgical and nonsurgical methods.

We tailor a therapy plan to each child and work closely with orthopedic surgeons to find the best time for surgical intervention and to avoid repetitive surgeries.

The following results have been reported after SEMLC:

• decreased oxygen consumption (as a result, children tire less easily)
• greater mobility
• improved or retained ability to walk
• less pain as our young patients age
• preserved joint mobility
• reduced risk of problems associated with misaligned muscles and bones

We also treat spasticity with selective dorsal rhizotomy (SDR), an innovative surgery on the lower spinal cord done in collaboration with Columbia's pediatric neurosurgeons. SDR entails identifying certain nerves via electrical stimulation, then separating and cutting them from the spinal cord.