Treatment Designed to Meet Your Child's Needs
When you bring your child to NewYork-Presbyterian for the treatment of spasticity or another movement disorder, we perform a complete assessment of your child's function. Your child's team then puts together a plan of care that may include one or more of the following treatments:
- Botulinum toxin: We use Botox injections to reduce spasticity and/or abnormal movements in a specific muscle or muscle groups.
- Baclofen pump: While baclofen given as an oral medication can decrease spasticity, its side effects (drowsiness, drooling, and confusion) can limit its effectiveness. We therefore prefer to give baclofen through a pump, into the space around the spinal cord (intrathecal baclofen). We primarily use this therapy to treat children with severe spasticity in both the arms and the legs.
- Baclofen trial: To determine if your child is a candidate for a baclofen pump or selective dorsal rhizotomy, we may give a test dose of baclofen (baclofen trial) to monitor the effect of the medication on spasticity. A baclofen trial gives you, your child, physicians, and therapists valuable information regarding your child's types of muscle tone, underlying problems that may be present, and sensitivity to the medication. It also helps us to establish a “road map” for your child's future care.
Physical and Occupational Therapy
Physical therapy consists of activities that will help to improve your child's flexibility, strength, mobility, and function. A physical therapist also designs, modifies, and orders adaptive equipment. Occupational therapies aim to reduce your child's muscle tone; improve range of motion, mobility, comfort, and strength; and enhance your child's independence and the ability to perform activities of daily living, such as dressing, eating, and bathing.
Our physical and occupational therapists:
- Identify the primary concerns of you and your child and provide support to address those concerns.
- Assess your child and suggest therapies.
- Assess equipment and suggest modifications, as needed.
- Provide clinical support, including preparing you and your child for other therapies; answering your questions regarding specific treatments, and assessing your child's response to therapies.
- Speak with school, home, and outpatient and rehabilitation therapists on behalf of you and your child.
Orthotics (also called orthoses) are braces or supports that we may use to support your child's treatment. In general, we use orthotics to limit unwanted motion in a joint, assist muscles that cannot be activated, improve balance, and create a more consistent walking pattern. Some orthotics can be particularly helpful when used with physical therapy and/or medications. At NewYork-Presbyterian, our multidisciplinary team evaluates orthotics for the best fit and their effectiveness in helping achieve the goals of your child's treatment.
When nonsurgical treatments are insufficient to help a child with spasticity or another movement disorder, we turn to surgery, which has helped improve mobility, function, and quality of life for many children. NewYork-Presbyterian is a leader in the use of minimally invasive surgery, which requires smaller incisions and is associated with a faster recovery than traditional surgery.
- Minimally invasive selective dorsal rhizotomy: NewYork-Presbyterian is only one of three centers in the United States and the only center in the Tri-State area to offer this minimally invasive surgery. We use it primarily to treat children with spasticity in the legs, although some children with spasticity in both the arms and legs benefit. The surgeon operates on the nerve roots leading to sensory nerves in the legs. The standard approach for selective dorsal rhizotomy — and the one that is most often performed throughout the country — requires the removal of five levels of bone from the back of the spine. With the minimally invasive approach, using intraoperative ultrasound and an operating microscope, our neurosurgeons remove only one level of bone through a 1.5-inch incision. This procedure is best for children with relatively good strength in the legs.
- Orthopedic surgery: A wide variety of orthopedic surgical options are available to treat spasticity. Examples include tenotomy (surgery on a tendon), arthrodesis (fusion of a joint), osteotomy (removal of a portion of bone), tendon transfer or lengthening, complex hip reconstruction, foot realignment surgery, and crouch gait surgery.