NumberRecommendationSee section
Principles of care4
1Children and young people with spasticity should have access to a network of care that uses agreed care pathways supported by effective communication and integrated team working.4
3If a child or young person receives treatment for spasticity from healthcare professionals outside the network team, this should be planned and undertaken in discussion with the network team to ensure integrated care and effective subsequent management.4
5Offer a management programme that is:
  • developed and implemented in partnership with the child or young person and their parents or carers
  • individualised
  • goal focused.
8Help children and young people and their parents or carers to be partners in developing and implementing the management programme by offering:
  • relevant, and age and developmentally appropriate, information and educational materials
  • regular opportunities for discussion and
  • advice on their developmental potential and how different treatment options may affect this.
14Monitor the child or young person's condition for:
  • the response to treatments
  • worsening of spasticity
  • developing secondary consequences of spasticity, for example pain or contractures
  • the need to change their individualised goals.
Physical therapy (physiotherapy and/or occupational therapy)4
20All children and young people with spasticity referred to the network team should be promptly assessed by a physiotherapist and, where necessary, an occupational therapist.4
34Following treatment with botulinum toxin type A, continuous pump-administered intrathecal baclofen, orthopaedic surgery or selective dorsal rhizotomy, provide an adapted physical therapy programme as an essential component of management.4
Intrathecal baclofen8
82Consider treatment with continuous pump-administered intrathecal baclofen* in children and young people with spasticity if, despite the use of non-invasive treatments, spasticity or dystonia are causing difficulties with any of the following:
  • pain or muscle spasms
  • posture or function
  • self-care (or ease of care by parents or carers).
Orthopaedic surgery9
107An assessment should be performed by an orthopaedic surgeon within the network team if:
  • based on clinical findings (see recommendation 16) or radiological monitoring, there is concern that the hip may be displaced
  • based on clinical or radiological findings there is concern about spinal deformity.

At the time of publication (July 2012), intrathecal baclofen did not have UK marketing authorisation for children younger than 4 years, nor did it have UK marketing authorisation for use in the treatment of dystonia associated with spasticity. Where appropriate, informed consent should be obtained and documented.

From: 1, Guideline summary

Cover of Spasticity in Children and Young People with Non-Progressive Brain Disorders
Spasticity in Children and Young People with Non-Progressive Brain Disorders: Management of Spasticity and Co-Existing Motor Disorders and Their Early Musculoskeletal Complications.
NICE Clinical Guidelines, No. 145.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2012 Jul.
Copyright © 2012, National Collaborating Centre for Women's and Children's Health.

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