Advertisement
Research Article| Volume 2, ISSUE 4, P867-889, November 1991

Spasticity and Its Management in Children

  • Teresa L. Massagli
    Correspondence
    Address reprint requests to: Teresa L. Massagli, MD, Department of Rehabilitation Medicine, Children’s Hospital and Medical Center, 4800 Sand Point Way NE, Seattle, WA 98105
    Affiliations
    Assistant Professor, Departments of Rehabilitation Medicine and Pediatrics, University of Washington School of Medicine and Children’s Hospital and Medical Center, Seattle, Washington
    Search for articles by this author
      This paper is only available as a PDF. To read, Please Download here.
      Spasticity is one component of the upper motor neuron syndrome with variable features depending on the underlying disease process. Treatment of spasticity should be guided by the impact of spasticity on function. A stepwise approach to treatment, beginning with basic physical measures, and progressing through medications to more permanent neurolytic and orthopedic procedures, is advocated. Clinical evaluation of the patient before and during treatment is crucial for selection of appropriate therapeutic measures.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.

      Content published before 2002 is available via pay-per-view purchase only.

      Subscribe:

      Subscribe to Physical Medicine and Rehabilitation Clinics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Abrams R.
        • Mubarak S.
        Orthopedic consequences of near drowning.
        Dev Med Child Neurol. 1989; 31 (Suppl 59): 25
        • Albright A.L.
        • Katzman A.
        • Singletary J.
        Intrathecal baclofen for spasticity in cerebral palsy.
        JAMA. 1991; 265: 1418-1422
        • Alfieri V.
        Electrical treatment of spasticity.
        Scand J Rehabil Med. 1982; 14: 177-182
        • Anderson R.J.
        • Raines A.
        Suppression of decerebrate rigidity by phenytoin and chlorpromazine.
        Neurology. 1976; 26: 858-862
        • Armstrong R.W.
        • Steinbok P.
        • Farrell K.
        • et al.
        Continuous intrathecal baclofen for the treatment of severe spasticity.
        Dev Med Child Neurol. 1989; 31 (Suppl 59): 21-22
        • Ashworth B.
        Preliminary trial of carisoprodol in multiple sclerosis.
        Practitioner. 1964; 192: 540-542
        • Bajd T.
        • Gregoric M.
        • Vodovnik L.
        • et al.
        Electrical stimulation in treating spasticity resulting from spinal cord injury.
        Arch Phys Med Rehabil. 1985; 66: 515-517
        • Baker L.L.
        • Parker K.
        • Sanderson D.
        Neuromuscular electrical stimulation for the head-injured patient.
        Phys Ther. 1983; 63: 1967-1974
        • Barolat G.
        Epidural spinal cord stimulation in the management of spasms and spasticity in spinal cord injury.
        Neurosurgery: State Art Rev. 1989; 4: 365-370
        • Barolat G.
        • Maiman D.J.
        Spasms in spinal cord injury: A study of 72 subjects.
        J Am Paraplegia Soc. 1987; 10: 35-39
        • Barolat-Romana G.
        • Davis R.
        Neurophysiological mechanisms in abnormal reflex activities in cerebral palsy and spinal spasticity.
        J Neurol Neurosurg Psychiatry. 1980; 43: 333-342
        • Barrette C.A.
        • Gage J.R.
        • Ounpuu S.
        • et al.
        Gait laboratory analysis of surgical intervention in spastic hemiplegia.
        Dev Med Child Neurol. 1990; 32 (Suppl 62): 4-5
        • Basmajian J.V.
        • Shankardass K.
        • Russell D.
        Ketazolam once daily for spasticity: Double blind cross-over study.
        Arch Phys Med Rehabil. 1986; 67: 556-557
        • Basmajian J.V.
        • Shankardass K.
        • Russell D.
        • et al.
        Ketazolam treatment for spasticity: Double blind study of a new drug.
        Arch Phys Med Rehabil. 1984; 65: 698-701
        • Bertoti D.B.
        Effect of short leg casting on ambulation in children with cerebralpalsy.
        Phys Ther. 1986; 66: 1522-1529
        • Binder H.
        • Eng G.D.
        Rehabilitation management of children with spastic diplegic cerebral palsy.
        Arch Phys Med Rehabil. 1989; 70: 481-489
        • Bleck E.E.
        Orthopedic management in cerebral palsy. MacKeith Press, London1987
        • Bohannon R.W.
        • Smith M.B.
        Interrater reliability of a modified Ashworth scale of muscle spasticity.
        Phys Ther. 1987; 67: 206-207
        • Botte M.J.
        • Keenan M.A.E.
        Reconstructive surgery of the upper extremity in the patient with head trauma.
        J Head Trauma Rehabil. 1987; 2: 31-45
        • Burke D.
        Spasticity as an adaptation to pyramidal tract injury.
        Adv Neurol. 1988; 47: 401-423
        • Burke D.
        • Hammond C.
        • Skuse N.
        • et al.
        A phenothiazine derivative in the treatment of spasticity.
        J Neurol Neurosurg Psychiatry. 1975; 38: 469-474
        • Byar D.P.
        • Simon R.M.
        • Friedewald W.T.
        • et al.
        Randomized clinical trials.
        N Engl J Med. 1976; 295: 74-80
        • Caplan A.L.
        • Callahan D.
        • Haas J.
        Ethical and policy issues in rehabilitation medicine.
        Briarcliff Manor. Hastings Center Report, NY1987: 1-20
        • Carlson S.J.
        A neurophysiological analysis of inhibitive casting.
        Phys Occup Ther Pediatr. 1984; 4: 31-42
        • Carpenter E.B.
        • Seitz D.G.
        Intramuscular alcohol as an aid in management of spastic cerebral palsy.
        Dev Med Child Neurol. 1980; 22: 497-501
        • Chapman C.E.
        • Wiesendanger M.
        Effects of dorsal cord stimulation in the cat and the monkey.
        Neurosurgery: State Art Rev. 1989; 4: 355-364
        • Cohan S.L.
        • Raines A.
        • Panagakos J.
        • et al.
        Phenytoin and chlorpromazine in the treatment of spasticity.
        Arch Neurol. 1980; 37: 360-364
        • Conine T.A.
        • Sullivan T.
        • Mackie T.
        • et al.
        Effect of serial casting for the prevention of equinus in patients with acute head injury.
        Arch Phys Med Rehabil. 1990; 71: 310-312
        • Cusick B.
        • Sussman M.
        Short leg casts: Their role in the management of cerebral palsy.
        Phys Occup Ther Pediatr. 1982; 2: 93-110
        • Davidoff R.A.
        Antispasticity drugs: Mechanisms of action.
        Ann Neurol. 1985; 17: 107-116
        • Davidoff R.A.
        Mode of action of antispasticity drugs.
        Neurosurgery: State Art Rev. 1989; 4: 315-324
        • Delwaide P.J.
        Electrophysiological analysis of the mode of action of muscle relaxants in spasticity.
        Ann Neurol. 1985; 17: 90-95
        • Denhoff E.
        • Feldman S.
        • Smith M.G.
        • et al.
        Treatment of spastic cerebral-palsied children with sodium dantrolene.
        Dev Med Child Neurol. 1975; 12: 736-742
        • Deyo R.A.
        • Centor R.M.
        Assessing the responsiveness of functional scales to clinical change: An analogy to diagnostic test performance.
        J Chron Dis. 1986; 39: 897-906
        • Donovan E.M.
        • Aronson D.D.
        Serial casting for equinus contracture in children with spastic cerebral palsy.
        Dev Med Child Neurol. 1990; 32 (Suppl 62): 4
        • Donovan W.H.
        • Carter R.F.
        • Rossi D.
        • et al.
        Clonidine: Effect on spasticity: A clinical trial.
        Arch Phys Med Rehabil. 1988; 69: 193-194
        • Duncan G.W.
        • Shahani B.T.
        • Young R.R.
        The efficacy of lioresal in the relief of flexor spasms and other aspects of “spinal spasticity.”.
        Neurology. 1974; 24: 382
        • Duncan W.R.
        Tonic reflexes of the foot.
        J Bone Joint Surg. 1960; 42A: 859-868
        • Duncan W.R.
        • Mott D.H.
        Foot reflexes and the use of the “inhibitive cast.”.
        Foot Ankle. 1983; 4: 145-148
        • Duquette P.
        • Murray T.J.
        • Pleines J.
        • et al.
        Multiple sclerosis in childhood: Clinical profile in 125 patients.
        J Pediatr. 1987; 111: 359-363
        • Easton J.K.M.
        • Ozel T.
        • Halpern D.
        Intramuscular neurolysis for spasticity in children.
        Arch Phys Med Rehabil. 1979; 60: 155-158
        • Eisenberg L.
        The social imperatives of medical research.
        Science. 1977; 198: 1105-1110
        • Engle H.A.
        The effect of diazepam (valium) in children with cerebral palsy: A double blind study.
        Dev Med Child Neurol. 1966; 8: 661-667
        • Erickson D.L.
        • Blacklock J.B.
        • Michaelson M.
        • et al.
        Control of spasticity by implantable continuous flow morphine pump.
        Neurosurgery. 1985; 16: 215-217
        • Erickson D.L.
        • Moreno P.
        • Lo J.
        • et al.
        Control of spasticity with intrathecal morphine sulfate.
        in: Muller H. Zierski J. Penn R.D. Local-spinal Therapy of Spasticity. Springer-Verlag, Berlin1988: 137-142
        • Feldman P.A.
        Upper extremity casting and splinting.
        in: Glenn M.B. Whyte J. The Practical Management of Spasticity in Children and Adults. Lea & Febiger, Philadelphia1990: 149-166
        • Ford F.
        • Bleck E.E.
        • Aptekar R.G.
        • et al.
        Efficacy of dantrolene sodium in the treatment of spastic cerebral palsy.
        Dev Med Child Neurol. 1976; 18: 770-783
        • Gajer A.
        • Costain K.
        • Zimbler S.
        Use of low-budget gait analysis system in surgical decision-making.
        Dev Med Child Neurol. 1990; 32 (Suppl 62): 37
        • Gans B.M.
        • Glenn M.B.
        Introduction.
        in: Glenn M.B. Whyte J. The Practical Management of Spasticity in Children and Adults. Lea & Febiger, Philadelphia1990: 1-7
        • Garland D.E.
        • Lilling M.
        • Keenan M.A.
        Percutaneous phenol blocks to motor points of spastic forearm muscles in head-injured adults.
        Arch Phys Med Rehabil. 1984; 65: 243-245
        • Garland D.E.
        • Lucie R.S.
        • Waters R.L.
        Current uses of open phenol nerve block for adult acquired spasticity.
        Clin Orthop. 1982; 165: 217-222
        • Garland D.E.
        • Rhoades M.E.
        Orthopedic management of brain-injured adults.
        Clin Orthop. 1987; 131: 111-122
        • Giebler K.B.
        Physical Modalities.
        in: Glenn M.B. Whyte J. The Practical Management of Spasticity in Children and Adults. Lea & Febiger, Philadelphia1990: 118-148
        • Glenn M.B.
        Nerve Blocks.
        in: Glenn M.B. Whyte J. The Practical Management of Spasticity in Children and Adults. Lea & Febiger, Philadelphia1990: 227-258
        • Glenn M.B.
        Case example: The management of spasticity after traumatic brain injury.
        in: Glenn M.B. Whyte J. The Practical Management of Spasticity in Children and Adults. Lea & Febiger, Philadelphia1990: 296-305
        • Gottlieb G.L.
        • Myklebust B.M.
        • Stefoski D.
        • et al.
        Evaluation of cervical stimulation for chronic treatment of spasticity.
        Neurology. 1985; 35: 699-704
        • Greenblatt D.J.
        • Shader R.I.
        • Abernethy D.R.
        Current status of benzodiazepines.
        N Engl J Med. 1983; 309: 410-416
        • Griffith E.R.
        • Melampy C.N.
        General anesthesia use in phenol intramuscular neurolysis in young children with spasticity.
        Arch Phys Med Rehabil. 1977; 58: 154-157
        • Guttman L.
        Spinal Cord Injuries: Comprehensive Management and Research. Blackwell Scientific, London1976
        • Guyatt G.
        • Sackett D.
        • Taylor D.W.
        • et al.
        Determining optimal therapy-randomized trials in individual patients.
        N Engl J Med. 1986; 314: 889-892
        • Haley S.M.
        • Hallenborg S.C.
        • Gans B.M.
        Functional assessment in young children with physical impairments.
        Top Early Child Spec Ed. 1989; 9: 106-126
        • Haley S.M.
        • Inacio C.A.
        Evaluation of spasticity and its effect on motor function.
        in: Glenn M.B. Whyte J. The Practical Management of Spasticity in Children and Adults. Lea & Febiger, Philadelphia1990: 70-96
        • Halpern D.
        • Meelhuysen F.E.
        Phenol motor point block in the management of muscular hypertonia.
        Arch Phys Med Rehabil. 1966; 47: 659-664
        • Harrison A.
        Spastic cerebral palsy: Possible spinal interneuronal contributions.
        Dev Med Child Neurol. 1988; 30: 769-780
        • Haslam R.H.A.
        • Walcher J.R.
        • Lietman P.S.
        • et al.
        Dantrolene sodium in children with spasticity.
        Arch Phys Med Rehabil. 1974; 55: 384-388
        • Hinderer K.A.
        • Harris S.R.
        • Purdy A.H.
        • et al.
        Effects of “tone-reducing” casts vs standard plaster casts on gait improvements in children with cerebral palsy.
        Dev Med Child Neurol. 1988; 30: 370-377
        • Hoffinger A.
        • Rab G.T.
        The hamstrings in cerebral palsy crouch gait.
        Dev Med Child Neurol. 1989; 31 (Suppl 59): 8
        • Hylton N.
        Dynamic casting and orthotics.
        in: Glenn M.B. Whyte J. The Practical Management of Spasticity in Children and Adults. Lea & Febiger, Philadelphia1990: 167-200
        • Jones J.
        • McLaughlin J.F.
        Mechanical efficiency of children with spastic cerebral palsy.
        Dev Med Child Neurol. 1989; 31 (Suppl 59): 6
        • Jones R.F.
        • Burke D.
        • Marosszeky J.E.
        • et al.
        A new agent for the control of spasticity.
        J Neurol Neurosurg Psychiatry. 1970; 33: 464-468
        • Joynt R.L.
        • Leonard J.A.
        Dantrolene sodium suspension in treatment of spastic cerebral palsy.
        Dev Med Child Neurol. 1980; 22: 755-767
        • Kadaba M.P.
        • Ramakrishnan H.R.
        • Wootten M.E.
        • et al.
        Intrasubject repeatability of phasic EMG data on the gait of children with cerebral palsy.
        Dev Med Child Neurol. 1989; 31 (Suppl 59): 48-49
        • Kaplan N.
        Effect of splinting on reflex inhibition and sensorimotor stimulation in treatment of spasticity.
        Arch Phys Med Rehabil. 1962; 43: 565-569
        • Katz R.
        • Pierrot-Deseilligny E.
        Recurrent inhibition of alpha-motoneurons in patients with upper motor neuron lesions.
        Brain. 1982; 105: 103-124
        • Katz R.T.
        Management of spasticity.
        Arch Phys Med Rehabil. 1988; 69: 108-116
        • Katz R.T.
        • Rymer W.Z.
        Spastic hypertonia: Mechanisms and management.
        Arch Phys Med Rehabil. 1989; 70: 144-155
        • Keenan M.A.E.
        The orthopedic management of spasticity.
        J Head Trauma Rehabil. 1987; 2: 62-71
        • Kelly M.
        Effectiveness of a cryotherapy technique on spasticity.
        Phys Ther. 1969; 49: 349-353
        • Kessler D.A.
        The regulation of investigational drugs.
        N Engl J Med. 1989; 320: 281-288
        • Knutsson E.
        • Martensson A.
        • Gransberg L.
        Antiparetic and antispastic effects in duced by tizanidine in patients with spastic paresis.
        J Neurol sci. 1982; 53: 187-204
        • Kottke I.F.
        The neurophysiology of motor function.
        in: Kottke J.G. Stillwell G.K. Lehmann J.F. Krusen’s Handbook of Physical Medicine and Rehabilitation. ed 3. WB Saunders, Philadelphia1982: 403-426
        • Laitinen L.
        • Singounas E.
        Longitudinal myelotomy in the treatment of spasticity of the legs.
        I Neurosurg. 1971; 35: 536-540
        • Lance J.W.
        Symposium synopsis.
        in: Feldman R.G. Young R.R. Koelle W.P. Spasticity: Disordered Motor Control. Year Book, Chicago1980: 485-494
        • Lehmann J.F.
        • deLateur B.J.
        Cryotherapy.
        Therapeutic Heat and Cold. Williams & Wilkins, Baltimore1982: 563-602
        • Lehmann J.F.
        • Price R.
        • deLateur B.J.
        • et al.
        Spasticity: Quantitative measurements as a basis for assessing effectiveness of therapeutic intervention.
        Arch Phys Med Rehabil. 1989; 70: 6-15
        • Leonard C.T.
        • Moritani T.
        • Hirschfeld H.
        • et al.
        Deficits in reciprocal inhibition of children with cerebral palsy as revealed by H-reflex testing.
        Dev Med Child Neurol. 1990; 32: 974-984
        • Little J.W.
        • Merritt J.
        Spasticity and associated abnormalities of muscle tone.
        in: DeLisa J. Currie D. Gans B.M. Principles and Practice of Rehabilitation Medicine. JB Lippincott, Philadelphia1988: 430-447
        • Little J.W.
        • Mickelsen P.
        • Umlauf R.
        • et al.
        Lower extremity manifestations of spasticity in chronic spinal cord injury.
        Am J Phys Med Rehabil. 1989; 68: 32-36
        • MacFaul R.
        • Cavanagh N.
        • Lake B.D.
        • et al.
        Metachromatic leukodystrophy: Review of 38 cases.
        Arch Dis Child. 1982; 57: 168-175
        • Madorsky J.G.B.
        Staged treatment of spasticity.
        West J Med. 1984; 140: 606-607
        • Marsh H.O.
        Diazepam in incapacitated cerebral-palsied children.
        JAMA. 1965; 191: 797-800
        • Mathiowetz V.
        • Bolding D.J.
        • Trombly C.A.
        Immediate effects of positioning devices on the normal and spastic hand measured by EMG.
        Am J Occup Ther. 1983; 37: 247-254
        • Matthews W.B.
        • Rushworth G.
        • Wakefield G.S.
        Dimethothiazine in spasticity.
        Acta Neurol Scand. 1972; 48: 635-644
        • Maxwell D.R.
        Some aspects of the pharmacology of decerebrate rigidity.
        Gen Pharmacol. 1975; 6: 1-7
        • Maynard F.M.
        Early clinical experience with clonidine in spinal spasticity.
        Para plegia. 1986; 24: 175-182
        • Maynard F.M.
        • Karunas R.S.
        • Waring W.P.
        Epidemiology of spasticity following traumatic spinal cord injury.
        Arch Phys Med Rehabil. 1990; 71: 566-569
        • McLellan D.L.
        The drug treatment of spasticity.
        Int Rehabil Med. 1983; 5: 141-142
        • McPherson J.J.
        • Becker A.H.
        • Franszczak N.
        Dynamic splint to reduce the passive component of hypertonicity.
        Arch Phys Med Rehabil. 1985; 66: 249-252
        • McPherson J.J.
        • Kreimeyer D.
        • Aalderks M.
        • et al.
        A comparison of dorsal and volar resting hand splints in the reduction of hypertonus.
        Am J Occup Ther. 1982; 36: 664-670
        • Merritt J.L.
        Management of spasticity in spinal cord injury.
        Mayo Clin Proc. 1981; 56: 614-622
        • Meythaler J.M.
        • Steers W.D.
        • Haworth C.S.
        • et al.
        Limitations and complications in the use of intrathecal baclofen.
        Arch Phys Med Rehabil. 1990; 71: 771
        • Milla P.J.
        • Jackson A.D.
        Controlled trial of baclofen in children with cerebral palsy.
        J Int Med Res. 1977; 5: 398-404
        • Mills V.M.
        Electromyographic results of inhibitory splinting.
        Phys Ther. 1984; 64: 190-193
        • Molnar G.E.
        • Evangelista L.A.
        • Kathirithamby R.
        Dantrolene sodium in spasticity: Long term administration in children.
        NY State J Med. 1978; 78: 1233-1237
        • Molnar G.E.
        • Kathirithamby R.
        Lioresal in the treatment of cerebral palsy.
        Arch Phys Med Rehabil. 1979; 60: 540
        • Mossberg K.A.
        • Linton K.A.
        • Friske K.
        Ankle-foot orthoses: Effect on energy expendi ture of gait in spastic diplegic children.
        Arch Phys Med Rehabil. 1990; 71: 490-494
        • Muller H.
        • Zierski J.
        • Dralle D.
        • et al.
        Intrathecal baclofen in spasticity.
        in: Muller H. Zierski J. Penn R.D. Local-spinal Therapy of Spasticity. Springer-Verlag, Berlin1988: 155-214
        • Nance P.W.
        • Shears A.H.
        • Nance D.M.
        Clonidine in spinal cord injury.
        Can Med Assoc J. 1985; 133: 41-42
        • Neilson P.D.
        • McCaughey J.
        Self-regulation of spasm and spasticity in cerebral palsy.
        J Neurol Neurosurg Psychiatry. 1982; 45: 320-330
        • Newman P.M.
        • Nogues M.
        • Newman P.K.
        • et al.
        Tizanidine in the treatment of spasticity.
        Eur J Clin Pharmacol. 1982; 23: 31-35
        • Nichols T.R.
        Coordination of muscular action in cat hindlimb by proprioceptive spinal pathways.
        Nuerosurgery: State Art Rev. 1989; 4: 303-314
        • Nogen A.G.
        Medical treatment for spasticity in children with cerebral palsy.
        Child’s Brain. 1976; 2: 304-308
        • Nwaobi O.M.
        • Brubaker C.E.
        • Cusick B.
        • et al.
        Electromyographic investigation of extensor activity in cerebral palsied children in different seating positions.
        Dev Med Child Neurol. 1983; 25: 175-183
        • Otis J.C.
        • Root L.
        • Kroll M.A.
        Measurement of plantar flexor spasticity during treat ment with tone-reducing casts.
        J Pediatr Orthop. 1985; 5: 682-686
        • Parke B.
        • Penn R.D.
        • Savoy S.M.
        • et al.
        Functional outcome after delivery of intrathecal baclofen.
        Arch Phys Med Rehabil. 1989; 70: 30-32
        • Penn R.D.
        Chronic cerebellar stimulation for cerebral palsy: A review.
        Neurosurgery. 1982; 10: 116-121
        • Penn R.D.
        • Kroin J.S.
        Intrathecal baclofen in the long-term management of severe spasticity.
        Neurosurgery: State Art Rev. 1989; 4: 325-332
        • Penn R.D.
        • Savoy S.M.
        • Corcos D.
        • et al.
        Intrathecal baclofen for severe spasticity.
        N Engl J Med. 1989; 320: 1517-1521
        • Powell M.M.
        • Silva P.D.
        • Grindeland T.
        Effects of two types of AFOs on the gait of children with spastic diplegia.
        Dev Med Child Neurol. 1989; 31 (Suppl 59): 8
        • Powers R.K.
        • Marder-Meyer J.
        • Rymer W.Z.
        Quantitative relations between hypertonia and stretch reflex threshold in spastic hemiparesis.
        Ann Neurol. 1988; 23: 115-124
        • Price R.
        • Bjornson K.F.
        • Lehmann J.F.
        • et al.
        Quantitative measurement of spasticity in children with cerebral palsy.
        Dev Med Child Neurol. 1990; 32 (Suppl 62): 13
        • Price R.
        • Lehmann J.F.
        Influence of muscle cooling on the viscoelastic response of the human ankle to sinusoidal displacements.
        Arch Phys Med Rehabil. 1990; 71: 745-748
        • Robinson C.J.
        • Kett N.A.
        • Bolam J.M.
        Spasticity in spinal cord injured patients: 1. Short term effects of surface electrical stimulation.
        Arch Phys Med Rehabil. 1988; 69: 598-604
        • Rose J.
        • Gamble J.G.
        • Burgos A.
        • et al.
        Energy expenditure index of walking for normal children and for children with cerebral palsy.
        Dev Med Child Neurol. 1990; 32: 333-340
        • Russell D.J.
        • Rosenbaum P.L.
        • Cadman D.T.
        • et al.
        The gross motor function measure: A means to evaluate the effects of physical therapy.
        Dev Med Child Neurol. 1989; 31: 341-352
        • Russman B.S.
        • Reaviel I.
        • Blaber M.E.
        • et al.
        Transcutaneous electrical stimulation for the treatment of spasticity.
        Dev Med Child Neurol. 1989; 31 (Suppl 59): 21
        • Rymer W.Z.
        • Powers R.K.
        Pathophysiology of muscular hypertonia in spasticity.
        Neurosurgery: State Art Rev. 1989; 4: 291-301
        • Sahrmann S.A.
        • Norton B.J.
        The relationship of voluntary movement to spasticity in the upper motor neuron syndrome.
        Ann Nuerol. 1977; 2: 460-465
        • Shahani B.T.
        • Cros D.
        Neurophysiologic testing in spasticity.
        in: Glenn M.B. Whyte J. The Practical Management of Spasticity in Children and Adults. Lea & Febiger, Philadelphia1990: 34-43
        • Silva P.D.
        • Powell M.M.
        • Grindeland T.
        Week to week variation in cadence, velocity, and stride length of children with spastic diplegia.
        Dev Med Child Neurol. 1989; 31 (Suppl 59): 50
        • Smith C.W.
        • Leventhal L.
        Surgical treatment of lower extremity deformities in adulthead-injured patients.
        J Head Trauma Rehabil. 1987; 2 (2): 53-56
        • Snow B.J.
        • Tsui J.K.
        • Bhatt M.H.
        • et al.
        Treatment of spasticity with Botulinum toxin: A double-blind study.
        Ann Neurol. 1990; 28: 512-515
        • Spira R.
        Management of spasticity in cerebral palsied children by peripheral nerve block with phenol.
        Dev Med Child Neurol. 1971; 13: 164-173
        • Sussman M.D.
        Casting as an adjunct to neurodevelopmental therapy for cerebral palsy.
        Dev Med Child Neurol. 1983; 25: 804-805
        • Sutherland D.H.
        Gait Disorders in Childhood and Adolescence. Williams & Wilkins, Baltimore1984
        • Taylor C.L.
        • Harris S.R.
        Effects of AFOs on functional motor performance in a child with spastic diplegia.
        Am J Occup Ther. 1986; 40: 492-494
        • Terrence C.F.
        • Fromm G.H.
        Complications of baclofen withdrawal.
        Arch Neurol. 1981; 38: 588-589
        • Thomas S.S.
        • Mazur J.M.
        • Wright N.
        • et al.
        Quantitative assessment of AFOs for children with cerebral palsy.
        Dev Med Child Neurol. 1989; 31 (Suppl 59): 7
        • Tseng T.
        • Wang S.C.
        Locus of action of centrally acting muscle relaxants, diazepam and tybamate.
        J Pharm Exp Ther. 1971; 178: 350-360
        • Twitchell T.E.
        The restoration of motor function following hemiplegia in man.
        Brain. 1951; 74: 443-480
        • Utili R.
        • Boitnott J.K.
        • Zimmerman H.J.
        Dantrolene-associated hepatic injury.
        Gastroenterology. 1977; 72: 610-616
        • Vallentyne S.W.
        • Vallentyne J.R.
        The case of the missing ozone: Are physiatrists to blame?.
        Arch Phys Med Rehabil. 1988; 69: 992-993
        • Vodovnik L.
        • Bowman B.R.
        • Winchester P.
        Effect of electrical stimulation on spasticity in hemiparetic patients.
        Int Rehabil Med. 1984; 6: 153-156
        • Watt J.
        • Sims D.
        • Harckham F.
        A prospective study of inhibitive casting as an adjunct to physiotherapy for cerebral-palsied children.
        Dev Med Child Neurol. 1986; 28: 480-488
        • Whitlock J.A.
        Neurophysiology of spasticity.
        in: Glenn M.B. Whyte J. The Practical Management of Spasticity in Children and Adults. Lea & Febiger, Philadelphia1990: 8-33
        • Whyte J.
        • Morrisey J.
        Motor learning and relearning.
        in: Glenn M.B. Whyte J. The Practical Management of Spasticity in Children and Adults. Lea & Febiger, Philadelphia1990: 44-69
        • Whyte J.
        • Robinson K.M.
        Pharmacologic management.
        in: Glenn M.B. Whyte J. The Practical Management of Spasticity in Children and Adults. Lea & Febiger, Philadelphia1990: 201-226
        • Yamada S.
        • Dayes L.
        • Knierim D.
        • et al.
        Control of mass spasms by longitudinal myelotomy.
        Neurosurgery: State Art Rev. 1989; 4: 345-354
        • Young R.R.
        • Delwaide P.J.
        Drug therapy: Spasticity.
        N Engl J Med. 1981; 304 (96-99): 28-33
        • Young R.R.
        • Wiegner A.W.
        Spasticity.
        Clin Orthop. 1987; 219: 50-62
        • Zablotny C.
        Using neuromuscular electrical stimulation to facilitate limb control in the head injured patient.
        J Head Trauma Rehabil. 1987; 2: 28-33
        • Zablotny C.
        • Andric M.F.
        • Gowland C.
        Serial casting: Clinical applications for the adult head injured patient.
        J Head Trauma Rehabil. 1987; 2: 46-52