Rivista: EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE Cod Rivista: EUR J PHYS REHABIL MED Lavoro: 2378-EJPRM titolo breve: REHABILITATION PROCEDURES IN THE MANAGEMENT OF SPASTICITY

S is a common symptom seen in many neurological conditions (stroke, multiple sclerosis, spinal cord injury, traumatic brain injury and other central nervous system lesions). It has been defined as a motor disorder characterized by a velocity-dependent increase in the tonic stretch reflexes (muscle tone) with exaggerated tendon jerks.1 This definition has greatly influenced the evaluation and treatment of spasticity for many decades. Based on this definition, spasticity assessment has typically focused on evaluating levels of increase in stretch and tendon reflexes, while spasticity treatment has been directed at reducing reflex hyperexcitability. However, the above definition of spasticity describes phenomena seen in patients while they are resting, and consequently assessment does not take into account its impact on functional movements. Spasticity is a major disabling symptom in many patients with spinal and/or cerebral lesions. During functional movements, spasticity manifests itself within the complex condition of the “spastic movement disorder”. The pathophysiology of the spastic movement disorder relies on multiple factors including abnormal supraspinal drive, abnormal control of reflex activities, and changes in muscle mechanical properties. The most widely used procedures for management of spasticity are represented by pharmacological treatment aimed at inhibiting reflex hyperexcitability. In the last decades, several non pharmacological procedures for treating spasticity have been put forward, including muscle stretching, muscle reinforcement, physical agents and pain management. These procedures may have both neurophysiological and biomechanical effects on the spastic movement disorder. In the present paper, the literature concerning nonpharmacological procedures in the treatment of spasticity was reviewed and discussed, taking into account the multifaceted pathophysiology of the spastic movement disorder. Although 1Neuromotor and Cognitive Rehabilitation Research Centre, Department of Neurological, Neuropsychological, Morphological and Movement Sciences University of Verona, Verona, Italy 2“Villa Melitta” Rehabililitation Clinic, Bolzano, Italy EUR J PHYS REHABIL MED 2010;46:423-38