A Critical View on the Importance of Treating Spasticity and New Options to Improve Function in Patients with Cerebral Palsy GMFCS I-III

Spasticity in patients with cerebral palsy is still an unclear concept which bases on the lesion of the upper motor neuron. The consequence is a loss of reflex control. The diagnosis is made during the static clinical exam and is transported into function. Spasticity is seen as an important factor which causes functional handicap as well as functional and later structural deformities. Because spasticity is considered a deteriorating factor for function, treatment of spasticity is one of the main columns in the treatment of children with spastic cerebral palsy. However, the diagnosis of spasticity during function is not possible up to now. Recent publications even raise doubts on the efficacy of spasticity treatment. On the other hand, spasticity is seen as a factor to compensate for weakness. New studies highlight the possibility of conditioning reflexes leading to an increase or decrease of reflex expression, hence spasticity. These facts query the treatment of spasticity and pave the way to new treatment concepts where experiencing successful movements can condition control of reflexes positively, without treating spasticity. This paper looks at the recent literature on new aspects of spasticity and describes the possible therapeutic consequences. The main shift in the treatment concept is to help patients cope with their spasticity and discover movement strategies in a large spectrum of movements. We describe possible modifications of the current treatment concepts. Movements should be carried out as an automatic muscle activity to reach the goal of an action which lets the patients experience success and joy. Dynamic orthotics help to keep the body segments in a functional adequate alignment, for an optimal movement experience under gravity, while the therapist intends to activate necessary but inactive muscles including eccentric muscle contractions. The patients discover new abilities and learn to move in a more efficient way. New feed-forward movement strategies are built up which help for activities in general. The need of spasticity compensating for weakness is reduced. These principles should be transported into daily life and sports. Sportive activities involve these therapeutic aims and the patients challenge themselves when they endeavour to improve.