Stroke Training and Awareness Resources (STARs)

Importance of treatment

Secondary complications arising from spasticity can:

  • Be distressing and painful for the patient
  • Be difficult to manage for involved carers & health professionals
  • Interfere with rehabilitation and affect outcomes
  • Mean that patients with poor functional outcomes usually need more long term care input including for the impact on mental well-being, confidence and depression
  • Prevent some patients returning to work activities resulting in loss of income and possible reliance on benefits
  • Incur health economic costs increasing the cost of rehab and longer-term care over time. For example the cost of treating a pressure sore due to immobility (per patient) is estimated at between £1,214 up to £14,108 for more severe pressure sores. The complications are also higher in more complex cases. (The cost of pressure ulcers in the UK. Journal of wound care 21(6):261-2, 264,266 June 2012 Dealey C, Posnett J, Walker A.)

Principles of Treatment

  • Effective tone management and treatment can prevent long term secondary complications arising
  • Spasticity management and treatment is included in multidisciplinary team assessment and goal planning
  • Aggravating factors are identified and managed effectively. This can include bladder or bowel discomfort, pain, effects of medication, participation in rehab due to fatigue or other comorbidities pre or post stroke
  • An appropriate 24-hour posture management programme including positioning, stretching, splinting as appropriate is agreed and implemented by all staff
  • Patient and carer education about the importance of participating in physical therapy and activity programmes and appropriate use of splints if required is implemented. This will help to promote awareness of the importance of tone management and self management strategies

Key point

Secondary complications of spasticity can be prevented or minimised. We can all make a difference to the long term outcomes for patients with spasticity.

Treat or not?

There are some circumstances where spasticity does not need to be actively treated:

  • If spasticity is not having an impact on the patient’s well being or rehabilitation progress
  • Spasticity can, in some instances, be used to help function. For example spasticity in the leg may help someone to stand

However, the principles of tone management must still be applied. Remember muscle tone can change over time and therefore requires repeated assessment and management.

Page last reviewed: 04 May 2020