Synopsis
Manage spasticity by function and triggers, preserve useful tone and recognise autonomic dysreflexia after high spinal injury as a hypertensive emergency requiring immediate trigger removal.
- Spasticity is a velocity-dependent increase in stretch reflex tone after upper-motor-neurone injury; spasms, clonus, stiffness, dystonia, rigidity and fixed contracture are related but not interchangeable findings.
- Tone can help standing, transfers, venous return or continence, so treatment targets pain, sleep, hygiene, skin, gait or care goals rather than a normal tone score.
- A sudden increase usually signals a trigger below the neurological level: urinary infection or retention, catheter blockage, constipation, pressure injury, fracture, ingrown nail, tight equipment or pain.
Key red flags
Previously stable tone suddenly increases with urinary symptoms, blocked catheter, constipation, pressure damage, fracture, tight splint, menstruation or another painful stimulus.
Investigation priorities
Separate neural spasticity from contracture and determine which activity, comfort or care outcome treatment should change.
Management branches
Tone, spasms or clonus becomes painful, functionally limiting or suddenly worse.
- Define one or more measurable goals and establish whether current tone helps posture or transfer, while distinguishing dynamic spasticity from fixed shortening or dystonia.
- Search systematically for bladder, bowel, skin, infection, fracture, pain and equipment triggers and correct these before escalating long-term antispastic treatment.
Key medicines
Oral baclofenA common adult start is 5 mg three times daily, increased gradually to the lowest effective dose.
TizanidineBegin at a low specialist-selected dose and titrate slowly according to daytime and nocturnal goals.