Management of spasticity in spinal cord injury.

Spasticity may be a major obstacle to rehabilitation of patients with spinal cord injury. It may cause discomfort, interfere with existing functions, or result in additional complications. Many techniques-physical, chemical, and surgical- exist for modulation of spasticity. Prevention of nociception and establishment of an effective daily stretching program are the foundation on which all other managements are based. Antispasticity medications may be added: benzodiazepines, dantrolene sodium, and baclofen are effective in selected patients. Motor point blocks may partially dampen spasticity in selected muscles of some patients. Chemical and surgical neurolytic procedures are used if the first two tiers of management are inadequate. Each technique can be rationally applied by use of a pyramidal management system.