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Cerebral palsy spasticity in adults

Adults with cerebral palsy live with spasticity throughout life, and many find it becomes more troublesome with age — more pain, more fatigue, and walking or hand use that was once manageable becoming harder. Spasticity management does not end at eighteen. Targeted injections, orthotics and rehabilitation planned around what matters to you can reduce pain and protect the function you have.

Cerebral palsy is lifelong, but most spasticity services are built around children. Adults with cerebral palsy often find that the structured treatment they received as children stops at transition, and that no one is looking at their tone as it changes through their twenties, forties and beyond. Yet spasticity in adulthood behaves differently from childhood: growth is finished, but joints, muscles and energy reserves have carried decades of altered loading, and pain and fatigue tend to increase.

What changes with age. Many adults with cerebral palsy describe walking becoming slower, more tiring and less safe; hips, knees and backs becoming painful; feet and ankles harder to keep in shoes and orthoses; and hands and arms tighter than they were. Some find that function they relied on — transfers, walking short distances, using a hand — begins to slip. Much of this is driven by spasticity acting on joints that are already worn, and much of it is treatable.

Assessment. The examination maps which muscles are overactive and what each is costing — pain, energy, safety, independence, care — and distinguishes spasticity from contracture and from the joint changes of a lifetime of altered loading, because each needs a different approach. Goals are set with you: less pain, walking that stays safe, a foot that fits a brace, a hand that opens, easier care. For adults who rely on tone to stand or transfer, the decision about what to treat is made carefully, muscle by muscle.

Treatment. Targeted injections into the specific muscles responsible reduce tone for a period of months and are repeated as needed. Orthotics, stretching and strengthening within the treatment window preserve and build on the gain, and equipment — walking aids, seating, footwear — is reviewed alongside, because a change in tone often changes what is needed. Where contracture is fixed or joints are damaged, orthopaedic opinion is arranged. Oral medication may be considered for widespread tone, weighed against its effect on energy and thinking.

Pain in adults with cerebral palsy. Pain is one of the commonest problems adults with cerebral palsy report, and it has several sources: spasticity itself, joints affected by years of abnormal loading, nerve compression at the wrist or elbow, and back pain from posture and seating. Dr Martin's training in both pain medicine and rehabilitation medicine means these are assessed together rather than passed between services. See also comprehensive pain assessment.

Who is seen and how to refer. Adults with cerebral palsy of any type and any level of mobility, including those transitioning from paediatric services and those who have never had spasticity treatment. Referrals are accepted from GPs, paediatric rehabilitation services, disability support providers and allied health practitioners. Telehealth assessment and review are available for rural and remote patients, with injection visits in Perth.

Sources: Cerebral Palsy Alliance; Healthdirect Australia.