ABSTRACT

There is no agreed evidence-based model available for the systematic pharmacological management of spasticity, and much of what is done is based on a logical and pragmatic approach. The use of drugs should of course always be an adjunct to good general management, with an emphasis on ongoing education of all involved, including the individual, family members, carers and health professionals. Providing an information sheet to complement verbal information can be extremely helpful in putting oral medication in the context of effective general spasticity management (Appendix 3). Continuity of care, combined with documentation of the evolving impact of spasticity, is necessary to enable ongoing assessment of change and to aid in the appropriate choice and timing of any pharmacological intervention. Knowledge of the trigger and aggravating factors detailed in Chapter 3 is particularly important, as they can exacerbate spasticity and its associated features. Far too often, pharmacological treatment is escalated before appropriate strategies to manage bladder and bowel function, skin integrity, soft tissue length and positioning are instigated. Attention to these simple but essential areas is paramount at all stages of management, and will ensure that drugs are used at appropriate times and dosages.