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Neurorehabilitation and Neural Repair
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Management of Spastic Hypertonia After Stroke

Richard T. Katz

Kessler Institute for Rehabilitation, 240 Central Avenue, East Orange, New Jersey 07018

Therapeutic intervention for the post-stroke hemiplegic with spastic hypertonia must be individualized to the patient's needs, but generally includes frequent range of motion. Therapeutic exercise, cold, or topical anesthesia may decrease reflex activity for short periods of time in order to facilitate minimal motor function. Casting and splinting techniques are extremely valuable to extend joint range diminished by hypertonicity. Dantrolene sodium is the pharamacologic agent of choice in the United States for the treatment of spastic hypertonia due to stroke. It is the only available drug that acts directly on muscle tissue. Peripheral electrical stimulation may have limited use in diminishing tone and facilitating paretic muscles. Phenol injections provide a valuable transition between short-term and long-term treatments, and offer remediation of hypertonia in selected muscle groups. Tenotomies and tendon transfers offer significant benefit in carefully chosen stroke patients, and the "SPLATT" procedure is one of the most successful rehabilitative surgeries. Achilles Tendon lengthening and release of long toe flexors may complement the SPLATT procedure in the management of the hemiplegic with spastic equinovarus.

Key Words: Key Words: muscle hypertonia • muscle spasticity • brain injury • stroke • neuropharmacology.

Neurorehabilitation and Neural Repair, Vol. 5, No. 5 suppl, S5-S12 (1991)
DOI: 10.1177/136140969100500502
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