Spasticity Assessment Clinic – Neurological Rehabilitation Outpatient Department – Walkergate Park

Spasticity is a symptom experienced by people who have a neurological condition such as a stroke, multiple sclerosis, spinal injury or cerebral palsy.

The message from the brain to the muscles doesn’t work effectively and makes your muscles work too hard and tighten up without you being able to do anything about it.

Spasticity takes different forms but the main things you may notice are: Tight muscles which pull the fingers of your hand into your palm, bend your elbow when you are trying to walk, bend your knee or make your leg shake.

Some people with spasticity have tight muscles all the time, some only have tight muscles when they try to do an activity.

Spasticity in itself may not be a problem. Some people with neurological conditions use the tightness of their muscles to maintain their ability to walk for example.

However, if untreated it can cause other problems such as muscles and tendons becoming stiff and short. If this continues then this may result in joints becoming immobile and stuck.
When spasticity does become a problem the ACTION acronym may help to identify this:
Activities which you were able to do may be more difficult due to the tightness and stiffness of your limbs.

Care tasks which you need help to do may be limited or more effortful.

Tight muscles may reduce your ability to stretch or position your joints.

Integrity of your skin may be at risk. This means that you may have problems with pressure sores or poor skin health due to being unable to get access to parts of your body for hygiene due to the tightness of your muscles.

Ongoing pain in your muscles or joints due to their position.

Nails may start to dig into the palm of your hand.

In the Spasticity Assessment Clinic more than one health professional will be involved in the assessment. They will assess if you have spasticity and how it impacts on your daily life.

They will discuss with you about what you feel the main problem is in relation to your tight muscles, general information about your past and present health, what medications you take and what interventions have already been tried.

You will then have a physical assessment. This may mean having to move your arms and legs so please do wear loose fitting clothes for your appointment.

From the assessment they will decide if you have spasticity or not and what the next steps are.

This initial appointment usually lasts approximately one hour.

• Please wear loose clothing where possible.
• Bring your medication list
• Bring your yellow INR book if you are on Warfarin.

Our clinic rooms are small, therefore please only bring one other person with you to the appointment.

If you have spasticity the following options will be discussed with you:
• Starting medication for muscle tightness
• Changing your current medication (if you are already on an appropriate tablet)
• Provision of botulinum toxin injections
• Use of splints/orthotics
• Or a combination of the above.

If botulinum toxin is felt to be appropriate, we will discuss with you about what it is used for, how it works, how long it takes to work and when it wears off and side effects that may occur.

If you choose to go ahead with botulinum toxin injections we will need your signed consent. We can carry out the injections in your best interests if you do not have the capacity to make that decision.

The botulinum toxin injections can be given to you on the day of your appointment or you can go home to consider it in more detail. Another appointment will be made for you if you choose to go ahead.

There is a leaflet available giving more details on botulinum toxin injections to help you make your decision.

If you decide to go ahead with botulinum toxin injections then we will discuss goals with you. This is just identifying what you hope that the injections will help with e.g. Being able to open my hand for cleaning and nail care. We will give you a form to complete every couple of weeks to monitor the goal over a period of time.

For your first two sets of injections you will be given a follow up appointment for the Therapy Review Clinic in approximately 4 to 7 weeks. The clinician will discuss with you if you have noticed any benefit/problems since you had the injections. This helps us to guide the next set of injections. This appointment lasts for approximately ½ hour.

You will also be given an appointment approximately four months after your first set of injections to return to the Spasticity Review Clinic. Here you will have another assessment, discussion and if you choose to go ahead, another set of botulinum toxin injections. This appointment lasts for approximately ½ hour.

You can continue to have injections as long as they are benefitting you.

Many things influence muscle tightness and may present as ‘spasticity’ or may make spasticity worse.

This may include medical issues such as the ones below. It is important to manage all of these to help reduce your muscle tightness. Please contact your GP if you have any problems with the following:
• Pain
• Problems with continence (constipation/diarrhoea)
• Pressure sores/skin rashes/skin integrity
• Infection
• Sleep deprivation
• Mood and anxiety
• General health status
• Postural management

There are lots of conditions that cause tight muscles but not all are due to spasticity.

If we feel you do not have spasticity then you will be discharged from the spasticity clinic but we may make recommendations for actions for you to take or make referral to other services we feel could help.

Referrals to the service can be made by a registered health professional involved in your care e.g. GP or other medic, Nurse, Physiotherapist, Occupational Therapist.

If they or you believe you have spasticity then a referral form can be completed. The referral will then be triaged (reviewed by members of the team) and if appropriate you will be put on the waiting list.

Waiting times for the clinic may vary dependent on the demand at the time but we strive to see everyone as soon as we can and within 18 weeks of referral.

You will receive an appointment letter. Please do contact us if you are unable to attend so we can arrange another appointment for you.

If you would like to speak to a member of the team before making a referral then please do so using the number at the back of this leaflet.

There is a referral form available from:
[email protected]

Spasticity Management Team
Neuro-Rehab Outpatients
Walkergate Park Centre for Neurological Rehabilitation and Neuro-Psychiatry
Benfield Road
Newcastle upon Tyne
NE6 5DN
Tel: 0191 287 5100
Email: [email protected]

If you want to make a comment, suggestion, compliment or complaint you can:
• talk to the people directly involved in your care
• ask a member of staff for a feedback form, or complete a form on the Trust website www.cntw.nhs.uk (click on the ‘Contact Us’ tab)
• telephone the Complaints Department 0191 245 6672
• email [email protected] Please note that information sent to the Trust via email is sent at your own risk
• We are always looking at ways to improve services. Your feedback allows us to monitor the quality of our services and act upon issues that you bring to our attention.
You can provide feedback in the following ways:
– the quickest way for you to do this is to complete our short online survey at www.cntw.nhs.uk/poy
– complete a Points of You survey, available from staff.

Christofi G et al (2018) Improving the management of post stroke spasticity: time for ACTION. Journal of Rehabilitation Medicine – Clinical Communications.

Further information about the content, reference sources or production of this leaflet can be obtained from the Patient Information Centre. If you would like to tell us what you think about this leaflet please get in touch.

This information can be made available in a range of formats on request (eg Braille, audio, larger print, easy read, BSL or other languages). Please contact the Patient Information Centre Tel: 0191 246 7288

Published by the Patient Information Centre
2021 Copyright, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust
Ref, PIC/851/0721 July 2021 V1
www.cntw.nhs.uk Tel: 0191 246 7288
Review date 2024