Spasticity Treatment In India

Last Modified: June 7, 2023  |   Created on: March 28, 2023

The cost of Intrathecal Baclofen Pump surgery for Spasticity in India is USD 16,000 – USD 17,000.

The word spasm has its origin in the Greek word (spasms) which means to ‘pull or drag’. It is also referred to as an unusual stiffness, and/or “pull” of muscles. Spasticity is usually caused by an imbalance or disproportion of signals from the central nervous system (brain and spinal cord) to the muscles.

Medically, Spasticity is a motor disorder in which specific muscles are unceasingly contracted. This is categorized by tight or stiff muscles and later on can interfere with normal movement, speech, and gait (manner of walking).

Spasticity affects negatively muscles and joints of the extremities and is particularly harmful in the case of growing children. Spasticity affects more than an estimated 12 million people worldwide.

It is isokinetic (abnormal but not increased movements), while other movement disorders and dystonia are hyperkinetic (abnormal and increased movements). However, spasticity is sometimes contemplated as or synonymous with hypertonicity (such as spastic dystonia, rigidity, or contractures), which results in the emergence of major misconceptions in spasticity management that have indirectly affected the person who is bearing it already. 

Similarly, for patients and families, varied forms of hypertonicity are categorized under the common umbrella term “stiffness.” This may be due to the reason that spasticity is a scientific concept therefore not easy to comprehend even for clinicians. 

Consequently, it’s difficult for clinicians to explain it to the patients or the families, especially when spasticity is not the only thing the patient is dealing with. The person is dealing with other forms of hypertonicity.

The patients and their families should focus on spasticity. It is even more challenging when the focus is on the unrealistic expectation to have a normal movement restoration; in situations when it is not possible.

In a nutshell, Spasticity can be explained as abnormal muscle tightness because of prolonged muscle contraction. It is a symptom related to damage to the brain, spinal cord or motor nerves. It is observed in individuals with neurological conditions, such as:

  • Cerebral palsy (CP)
  • Multiple sclerosis (MS)
  • Stroke
  • Traumatic brain or spinal cord injury

Spasticity can distress muscles in any part of the body but is most common in leg muscles.

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Symptoms and Causes of Spasticity

Symptoms can vary among individuals and can be painful, disfiguring and disabling.

Voluntary movement comprises a series of communications between muscles and the brain, with signals transmitted through the nerves and spinal cord.

This in turn affects the flow of signals to and from the muscles. However, involuntary movements may include spasms (brisk and/or sustained involuntary muscle contraction) and clonus (series of fast involuntary contractions).

People with brain injury, spinal cord injury, cerebral palsy or multiple sclerosis can have varying degrees of spasticity.

Congenital conditions or other factors affect a particular area of the brain, spinal cord or nerves:

  • pain
  • difficulty with care and hygiene
  • bone and joint deformities
  • increased muscle tone
  • muscle stiffness, triggering movements to be less precise and making certain tasks difficult to perform.
  • muscle and joint deformities
  • abnormal posture
  • contractures (a permanent contraction of the muscle and tendon due to severe persistent stiffness and spasms)
    overactive reflexes
  • decreased functional abilities and delayed motor development
  • inhibition of longitudinal muscle growth
  • inhibition of protein synthesis in muscle cells

Reflex messages from the muscles may not reach the brain, or too many disorganized signals from the brain to the muscle may prevent it from responding normally.

As spasticity is mainly caused by damage to nerve pathways within your brain or spinal cord that control movement and stretch reflexes.

Spasticity may occur due to several conditions, including

  • Spinal cord injury.
  • Multiple sclerosis (MS).
  • Cerebral palsy.
  • Stroke.
  • Krabbe disease
  • Brain or head injury.
  • Amyotrophic lateral sclerosis (ALS), also known as Lou
  • Gehrig’s disease.
  • Hereditary spastic paraplegias.
  • Adrenoleukodystrophy (ALD).
  • Phenylketonuria

These factors and conditions which cause spasticity to impact the lifestyle of the individuals as

  • It can be painful.
  • Spasticity can cause a loss of range of motion in your joints.
  • To sit longer may get painful and sometimes impossible.
  • Spasticity in chest muscles, makes it challenging to take deep breaths.
  • Repeated muscle spasms may affect sleep and its pattern.
  • It can make movements harder to control.

There could be further, more evident complications

Left untreated, moderate to severe spasticity can also lead to:

  • Urinary tract infections (UTI)
  • Chronic constipation
  • Partial or full dislocation of joints
  • Fever or other systemic illnesses
  • Pressure sores
  • Frozen joints

Complications of spasticity can vary from individual to individual.
The severity can directly impact, daily functioning and cause excruciating pain. Performing daily hygiene tasks and basic care could also be disrupted. Consequently, this increases the risk of developing pressure injuries (bedsores), which may lead to infection and sepsis.

Spasticity and its diagnosis

Prolonged and untreated spasticity can cause frozen joints and/or pressure sores on the skin, which are very painful.

  • It is important to consult a specialist when spasticity any symptom of spasticity surfaces for the very first time, even if it’s with no known cause.
  • At that point in time spasticity is worsening and becomes more frequent. The individual experiences pain due to stiff joints and muscles or the condition is interfering with the daily chores. The specialist may then immediately refer to further testing or physical therapy. A doctor then examines the patient’s medical history based on which the grade and severity of Spasticity are assessed.
  • A medical history along with previous medical incidents helps the doctor to determine the cause and type of Spasticity.
  • The severity of spasticity can be evaluated on the basis of several grading systems and a clinical pattern.
  • An appropriate treatment and its course may then be determined based on the results of the grading. Later on, several tests can help to confirm the diagnosis.
  • A proper assessment of the individual’s clinical and neurological status is essential in making an effective treatment plan with achievable goals, which is most critical.

Diagnosis of spasticity is mostly based on a clinical evaluation that should include:

  • clinical history
  • physical examination
  • evaluation of stretch reflexes (e.g., deep tendon reflexes, involuntary muscle contractions provoked by stretching the muscle with a tap on the tendon that connects the muscle to a bone)
  • assessment of passive and active motion
  • function, e.g., toileting, eating, sleeping, dressing, sitting, standing or walking

The diagnosis is not complicated for rehabilitation specialists. However, a lot of other specialists are not trained and may not recognize the symptoms. Even if they do so, they may not see the potential benefit of an adapted treatment.

Spasticity is suspected based on possibly two things:

  • a history of a neurological disorder
  • on a specific abnormal posture.

Only then, it is confirmed if the patient shows increased resistance to passive movements that grow with speed and typical positioning of the limbs, because of increased muscle tone.

It should be noted that the features of spasticity should be assessed individually for each patient, with a focus on three main areas:

  • The overall motor difficulties.
  • The ability to control the muscles.
  • How muscle stiffness and any contractures worsen the functional problems.

The clinical pattern* helps to identify the muscles affected by spasticity which helps to determine an appropriate treatment.

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Spasticity in Cerebral Palsy (CP)

  • Spasticity in people with CP is caused due to any damage to the part of the brain that controls muscle tone and movement.
  • Arm and leg muscles may be affected.
  • Infants Children may not show spasticity symptoms, however, later get diagnosed with cerebral palsy, as the problem can become more evident over time as the child matures.

Spasticity in Multiple Sclerosis (MS)

People with MS impact leg and hip muscles, resulting in flexor spasticity (legs and hips locked in a bent position) or extensor spasticity, where stiff muscles hold the legs straight and sometimes crossed at the ankles.


The development of realistic and clinically relevant goals for each individual is the key to a successful treatment. The expectation or the desired result should be clear.

The chief aim of treatment is to simplify life for people with spasticity and for their caregivers, to improve their quality of life. So, improvement in function is a key long-term factor in spasticity management rather than a complete cure.

There’s an entire team to manage spasticity and any goals that are set should be defined and followed up in collaboration with this team. This spasticity management team may include:

  • A specialist in physical medicine and rehabilitation
  • A neurologist
  • A physiotherapist
  • Speech and language pathologist
  • An occupational therapist
  • An Orthopaedic surgeon
  • A neurosurgeon and an orthotist (specialist concerned with the design, manufacture and application of orthoses).

Nonsurgical Treatments for Spasticity

Nonsurgical treatments for spasticity include

Physical therapy: which aims at improving the range of motion and mobility. A physical therapist normally focuses on lower extremity stretching and strengthening exercises and mobility training (transfers, standing and walking).

Occupational therapy: aims at improving strength and coordination allowing for improved performance of daily tasks. An occupational therapist largely emphases more on upper extremity stretching, strengthening and training to perform daily activities, such as grooming, bathing and cooking.

Speech therapy: spasticity sometimes affects the mouth, face and throat muscles. A speech therapist can help such patients with speech, communication and swallowing in a much-guided manner.

Casting or bracing: avoids involuntary spasms and diminishes tightening of the muscles. Using casts or braces for affected regions of the body offers a continued stretch of spastic muscles to improve the range of motion and can facilitate function.

Assistive devices: help a person with spasticity move around and perform daily tasks more efficiently, independently and safely.

There are a wide variety of assistive devices:

  • positioning aids
  • universal cuffs
  • j-neck canes
  • quad canes
  • hemi-walkers
  • gait trainer
  • communications boards
  • adaptive utensils, with better grip
  • nosy cups
  • leg lifters
  • braces
  • standing frames
  • bath chairs

Oral Medications

Oral medications are prescribed in combination with other therapies. They usually only prescribe medications if a particular form of spasticity disrupts daily functioning or sleep. Common medications for spasticity include:

  • Baclofen
  • Tizanidine
  • Dantrolene sodium
  • Diazepam
  • Clonazepam
  • Gabapentin

Oral medications for spasticity are often effective but may cause side effects such as drowsiness and weakness.

Botox Treatment for Spasticity

This therapy is usually a consideration when spasticity needs to be relieved in only a few muscle groups. It can be used in addition to other treatments for spasticity.

  • Botox is injected into carefully selected sites, in small amounts. These areas are ascertained based on the pattern of spasticity.
  • Botox injections can last up to 12-16 weeks, but, due to the elasticity of the nervous system, new nerve endings will come up and the muscle will no longer be inhibited by the Botox. Botox can be very helpful, however, there is a limited number of injections that can be administered.

Surgical Treatments for Spasticity

Surgical treatments for spasticity are recommended mostly in severe cases. These types of treatment include

Intrathecal baclofen (ITB) therapy

  • A pump is placed surgically in the abdomen that releases a steady dose of the medication baclofen directly to the spinal fluid through a catheter connected to the pump.
  • This can lead to a significant reduction in spasticity and pain with a lower risk of drowsiness compared to taking baclofen orally.
  • ITB pump therapy should only be considered in extreme cases of spasticity.

Selective dorsal rhizotomy (SDR)

  • Surgeons only perform this procedure for severe spasticity affecting the legs.
  • Spasticity can be caused by an imbalance in electrical signals to certain muscles. SDR rebalances the electrical signals sent to the spinal cord by surgically cutting carefully selected nerve roots.
  • Accurate cutting of problematic nerve roots reduces muscle stiffness while preserving other functions.
  • SDR is recommended mostly for people with cerebral palsy.

Orthopedic surgery

  • This involves surgery that deals with treating the after-effects of spasticity on muscles, bones and connective tissue, such as contractures and deformities like tendon lengthening and tendon transfer procedures.
  • Intrathecal Baclofen therapy is coming up to be one of the most hopeful modalities of controlling Spasticity and helping the patient to ambulate with support.


  • A surgical procedure that comprises a neurosurgeon accessing the cable-like sensory nerves along the spine and carefully isolating the nerves that send contraction messages to the affected muscles.
  • The surgeon cuts the most abnormal fibers to relieve the spasticity while preserving other motor and sensory functions.

Regular follow-ups

  • It is recommended to follow up with the doctor regularly to ensure proper treatment of the condition.
  • After surgeries like baclofen pump placement, patients are followed by their neurosurgeon who sees them for 3 months, 6 months and 12 months.
  • Follow-ups for medicine dosing or any device-related concerns should not be lingered on or missed.
  • Patients who take oral medications or who are under any physical and/or occupational therapy should follow up with their doctors as instructed and needed.

Adaptive Equipment

Adaptive equipment definitely helps individuals with cerebral palsy. Functional independence too maximizes without a doubt. These tools encourage individuals to be more physically active and practice movements affected by motor impairments.

However, individuals with cerebral palsy should try to avoid overdependence on adaptive tools and try to practice these tasks without them when possible as it stimulates neuroplasticity and encourages better motor control.

Spasticity affects over 12 million people across the globe. This number includes around 80% of people with cerebral palsy and 80% of those with multiple sclerosis.

There may be a treatment for every and individual with spasticity, but only a progressive and optimistic approach, trust in the treatment and an early diagnosis initiative are the prerequisites.

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