Spasticity treatment is important because the increased tone may interfere with the physical functioning of patients. The overarching goal of spasticity management should be to improve the ability of patients to perform active and passive ranges of motion and improve the ability of caregivers to assist patients with disabilities. Increased tone or spasticity is the tightness that patients and/or caregivers report with passive movement of the limb. In more scientific language, spasticity is a motor disorder characterized by a velocity-dependent increase in the tonic stretch reflex. A clinical finding on the neurologic examination, spasticity, together with increased tone, brisk reflexes with incoordination, and weakness, represents the upper motor neuron syndrome.

Regardless of the cause, spasticity causes significant disability. An estimated 4 million individuals are stroke survivors in the United States, and as many as one third may have spasticity with sufficient disability to require treatment. According to the Centers for Disease Control and Prevention, 1.4 million people in the United States sustain a traumatic brain injury each year, and additional patients develop spasticity after spinal cord injury. The result of any brain or spinal cord injury is a variable pattern of increased tone with weakness and discoordination that leads to significant disability in many patients.

The treatment of spasticity relies on the physician’s assessment of the individual together with conversations with the caregiver. Patients’ inability to perform simple activities of daily living for themselves and the adverse effects on the caregiver drive physicians to find ways to decrease tone, build strength, and improve coordination. The team approach is a cornerstone of a successful treatment, and interaction of the patient, the caregiver, the therapist, and the physicians works best to provide a care plan that addresses functional impairment and plots a course to treat the problems.

Spasticity is a clinically relevant medical problem when it interferes with function or care of patients. The evolution of upper motor neuron syndrome may take days to months after a central nervous system injury. Moreover, the presentation in one patient may differ from that of another despite both having similar central nervous system lesions. The lesion alone does not predict the amount or impact of the spasticity. Other factors such as medications, stress, medical illness, timing of therapy, and so on impact the clinical presentation. As a result, each patient must be assessed individually with his or her caregiver, noting the concerns that impair the performance of activities of daily living or other deficits. No matter how much we learn about stroke, traumatic brain injury, multiple sclerosis, and spinal cord injury, the assessment of spasticity and the effect of tone on function will remain unique to each individual patient’s circumstance.

Although neurologic examination is essential for the diagnosis of spasticity, the management of spasticity has many paths for treatment depending on the disability and goals of the patient and caregiver. One patient may benefit from a combination of tools for spasticity, including interventions such as botulinum toxin injections and intrathecal baclofen, whereas others may require a more conservative route such as splinting or oral medications. The informed physician should know how to assess the amount of spasticity, determine the functional limitations it creates, and then be able to develop a management plan for that individual patient.

How to assess the complicated picture of spasticity and when to intervene are the focus of this text. Our coauthors define for you why spasticity is important and detail the diagnosis and management options, but the goal is to provide the reader with the best options for the physician’s individual patient. As editors, we aim to explore the diagnosis and management of the many different types of patients with spasticity and to open the door to the different treatment paradigms for patients with spasticity. This second edition has been updated to reflect the newest assessments and treatments.

So why is spasticity important? The answer is because it often causes disability and impairs function in our patients. The goal of this book is to provide the foundation for excellent care of our patients facing these disabilities.