Center for Spasticity

The multi-disciplinary Elly Hammerman Center for Spasticity (EHCS) was created to manage children’s symptoms of spasticity and dystonia. The treatment of spasticity and dystonia is complex and has changed considerably over the past few years.

Through the EHCS, a team of physicians, therapists and other health care professionals discusses treatment alternatives and chooses the best option for the child. This allows for the integration of information from multiple disciplines when developing a treatment plan for the child.

Conditions We Treat

Spasticity: a condition in which a patient experiences muscle tightness or stiffness in the arms, legs, trunk, neck or face.
Dystonia: a movement disorder leading to repeated twisting or holding of unusual positions.

Treatment Program

EHCS offers several treatment options ranging from non-invasive to surgical intervention. They include:

• Heat
• ROM/Stretching
• E-Stim
• Serial Casting
• Orthotics
• Splinting
• Oral Medications
• Nerve and Motor Point Blocks
• Selective dorsal rhizotomy
• Intrathecal Baclofen therapy (Baclofen Pump)
• Orthopaedic surgery

Treatment Options

Heat: moist heat application is used prior to muscle stretching to improve elasticity of muscle fibers.

ROM/Stretching: to improve the integrity of joints and muscle flexibility and to allow for better alignment and positioning.

E-Stim: an innovative method of treatment used by applying electrical stimulation to atrophied muscle fibers resulting in improved performance of muscle activity.

Serial Casting: the repeated application of plaster or fiberglass casts to gradually increase and restore functional soft tissue extensibility and delay or prevent the need for surgery. This method is often used following treatment of BOTOX injections of the foot and ankle.

Orthotics: custom molded lower limb positioning device designed to improve function and preserve range of motion. Fabricated from a variety of plastic material these orthotics are commonly worn during day or nighttime hours.

Splinting: the fabrication of splints to provide a prolonged muscle stretch, preserve range of motion and stability of joints as needed to improve the overall functional use of extremities.

Oral Medication: various oral medications are being used to decrease spasticity, which are customarily monitored by a neurologist. Drugs such as Baclofen or Tizanidine, have the effect of causing sedation and have had varying degrees of effectiveness. These medications are often the first line of treatment for spasticity. However, these oral medications are not for some children.

Nerve and Motor Point Blocks: nerve blocks decrease muscle tone (tightness of muscles) and have been quite successful in the past. Blocks are used to loosen muscle in a patient who has improving spasticity, is a very young child or for a specific muscle that is causing trouble. A physiatrist, neurologist or orthopaedic surgeon often administers these drugs with an injection directly into the muscle. Botox, phenol or alcohol are the most commonly used drugs but no one drug has proven to be more effective than the other. The effect of the nerve block usually lasts 3-6 months. If the block is effective in decreasing tightness, but the problem returns, a selective neurectomy can be performed by the orthopaedist or neurosurgeon to permanently reproduce the effect of the block.

Rhizotomy: a rhizotomy is a spinal operation performed by a pediatric neurosurgeon which effectively decreases spasticity in the lower extremities . The surgery involves sectioning the dorsal nerve roots that are abnormal and involved in the spasticity. It requires extensive physical therapy after surgery.

Baclofen Pump: this is a relatively new treatment option for spasticity. The baclofen pump infuses continuous medication, on a 24 hour basis, into the spinal canal of a child. The pump, roughly the size of a hockey puck, is inserted by the neurosurgeon and is placed under the skin in the abdomen of the child. The pump needs to be refilled in the office approximately every 8-12 weeks. The pump has been shown to effectively reduce overall spasticity and dystonia (involuntary motions of the upper and lower extremities) in patients. The pump requires intensive follow-up and frequent visits to the office for a medication refill for as long as the pump is in place. The pump cannot treat fixed contractures .

Orthopaedic Surgery: the orthopaedic surgeon deals mainly with mechanical malalignment. If the hip is dislocated, the leg is twisted or the spine is severely curved these will often require surgical intervention. Common procedures performed on children with spasticity include:

• Tendon transfers
• Osteotomies
• Fusion
• Open reduction
• Tendon Lengthening