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Spasticity: Non-pharmacological Rehabilitation Interventions

Backus D, Williams J, Mirkowski M, Morrow S, Short C, Donkers SJ, Bruno T, on behalf of the MSBEST Team. (2019). Spasticity: Non-pharmacological Rehabilitation Interventions. Multiple Sclerosis Best Evidence-Based Strategies and Treatment/Therapies for Rehabilitation. Version 1.0: p. 1-59.

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This module provides a comprehensive overview of the available evidence for non-pharmacological interventions for spasticity rehabilitation in persons with multiple sclerosis

Key Points

  • Group exercise training targeting flexibility, strength, and balance may improve spasticity in persons with MS.
  • Locomotor training using body weight supported treadmill training may reduce lower extremity spasticity in persons with secondary progressive MS.
  • It is unclear if unloaded leg cycling alone improves clinical measures of spasticity in persons with MS; however, it may have a positive impact on subjective measures of spasticity.
  • Unloaded leg cycling may improve spasticity in combination with pharmacological management.
  • Participation in recreational sports activities such as sports climbing or yoga may not reduce spasticity in persons with MS.
  • Hydrotherapy may improve subjective measures of spasticity more than land-based exercise in persons with MS.
  • Cryotherapy may not reduce clinical measures of spasticity in persons with MS; however, cryotherapy may have a positive impact on subjective measures of spasticity.
  • Repetitive transcranial and trans-spinal magnetic stimulation may reduce spasticity in persons with MS.
  • Intermittent theta-burst stimulation may be an effective intervention to reduce spasticity in persons with relapsing-remitting MS.
  • Transcranial direct current stimulation may not improve spasticity in persons with relapsing-remitting MS.
  • Transcutaneous electrical nerve stimulation may not reduce spasticity in persons with MS.
  • Subcutaneous nerve stimulation (SCNS) may reduce spasticity in persons with MS. SCNS does not seem to be harmful and may temporarily reduce clonus at the ankle.
  • Spinal cord stimulation may be a beneficial modality for treating spasticity in persons with MS.
  • Hip flexion assist orthoses may not be an effective intervention to reduce lower limb spasticity in persons with MS. There is no evidence related to the utility of other types of orthoses for reducing spasticity in persons with MS.
  • Radial shock wave therapy may be effective for reducing spasticity in persons with MS.
  • Reflexology may reduce spasticity in persons with MS.
  • Acupuncture may reduce spasticity in ambulatory persons with MS.
  • It is unclear if massage therapy improves spasticity in the lower extremities of persons with MS.
  • Intermittent theta-burst stimulation, in combination with exercise therapy, may reduce spasticity in persons with relapsing-remitting MS.
  • Combining massage therapy with exercise therapy may not reduce spasticity in persons with MS more than either therapy alone.
  • The use of supported standing may not improve spasticity more than a home exercise program in persons with secondary progressive MS.
  • Whole body vibration, in combination with exercise, may not reduce clinical measures of spasticity in persons with MS; however, it may have a positive impact on subjective measures of spasticity.
  • Functional electrical stimulation-supported lower extremity cycling may reduce spasticity immediately following treatment in persons with chronic progressive MS.
  • Multidisciplinary inpatient rehabilitation may not improve subjective measures of spasticity in clinically stable persons with MS.
  • Both orthopedic surgical and neurosurgical interventions may be effective for reducing severe spasticity in persons with MS.
  • Transcutaneous electrical nerve stimulation may reduce lower extremity spasticity in persons with MS to a greater degree than oral baclofen.
  • Oral baclofen in combination with a stretching program may reduce spasticity more than placebo in persons with MS, but may not be more effective than baclofen alone.
  • A combination of oral dantrolene sodium and physical therapy interventions following surgical management of contractures may improve spasticity in persons with severe MS.
  • Botulinum toxin, when followed by early physiotherapy, may provide greater reduction in spasticity than botulinum toxin alone in persons with secondary progressive MS.
  • Segmental muscle vibration, or a combination of segmental muscle vibration with botulinum toxin, may provide greater reduction in spasticity in persons with secondary progressive MS compared to botulinum toxin alone.