Techniques to Modify Spasticity Before Implementing Physical Therapy

A variety of techniques may be used to better control or decrease spasticity before the therapist moves on to proper positioning, strengthening exercises, or functional therapies. When manual pressure is applied to the tendon during a stretch, it acts as a counterstimulant to offset the spasticity. In joint co-contraction and sustained stretch, partial weight is applied to the arm as it is stretched and tilt or standing tables are used to have the patient bear weight and decrease the muscles tone during stretch. Slow repetitive activities usually decrease spasticity—during passive exercise, the therapist moves the patientıs body parts in diagonal directions opposite each other, with the patient either lying down or draped over a large ball. With slow spinning, the patient is suspended in a hammock or seated in a rotating chair and slowly spun around.

Reciprocal inhibition is the proposed basis of vibration therapy in which vibration is applied to the tendon of the antagonist muscle. Cryotherapy and heat therapy involve the application of cold and warm packs, respectively, to spastic muscles (usually for 20 minutes or longer). Warmth can also be delivered through warm water or whirlpool baths, moist heat packs, and ultrasound. While the effect usually lasts only 30 to 60 minutes, this may be enough time to temporarily ease pain or allow for greater stretching during range of motion exercises.

	Functionally Based Therapies