The Role of Spasticity in Functional Neurorehabilitation-Part II: Non- pharmacological and Pharmacological Management: A Multidisciplinary Approach

The symptom/clinical sign of spasticity constitutes a negative factor when considering FNR for both the quadruped animal and the human biped. The existence of multidisciplinary protocols, based on neuroscience, is essential for patients to develop a coordinated motor function. Thus, a multi-modal approach to spastic movement disorder is required. In the quadruped animal an association between thermotherapy, transcutaneous eletrical stimulation (TENS) (50 Hz for 30 minutes) and resistance training in the under water treadmill (UWTM), followed by passive stretches, for 5 days a week during the initial stages of spasticity, has a significant and positive impact in patients’ motor coordination and functionality. It is possible to assume, through clinical evidence, that, by neuroanatomical comparison, similar protocols will reveal the same level of success if applied to the human biped. An early intervention, associated to a multimodal approach of stretching, thermotherapy, TENS and UWTM allows for a successful FNR. To complete the multidisciplinary approach, in the more severe cases it is possible to provide pharmacological support for the management of neuropathic pain and muscular relaxation. This support can be either local (botulinum toxin) or systemic.