Which of the following represents a next-step consideration for a patient with severe spasticity not controlled by non-pharmacological methods and oral medications?

Which of the following represents a next-step consideration for a patient with severe spasticity not controlled by non-pharmacological methods and oral medications?

• A. Repeat passive range of motion every hour
• B. Initiate intrathecal baclofen pump or botulinum toxin injections alongside continued PT
• C. Discontinue all physical therapy
• D. Allow spasticity to run its course without intervention

Answer: (B)

When severe spasticity remains after trying nonpharmacologic measures and oral medications, escalate to targeted therapies while continuing rehabilitation. An intrathecal baclofen pump delivers medication directly into the spinal fluid, producing stronger spasticity relief with fewer systemic side effects than oral baclofen. Botulinum toxin injections can address focal, muscle-specific spasticity, helping to reduce tone in troublesome areas. Using these approaches alongside ongoing physical therapy supports range of motion, prevents contractures, and improves functional ability. Repeating passive range-of-motion hourly isn’t a recognized next-step strategy, and stopping therapy or letting spasticity progress would undermine goals. So, initiating intrathecal baclofen pump therapy or botulinum toxin injections with continued PT is the appropriate next step.

When severe spasticity remains after trying nonpharmacologic measures and oral medications, escalate to targeted therapies while continuing rehabilitation. An intrathecal baclofen pump delivers medication directly into the spinal fluid, producing stronger spasticity relief with fewer systemic side effects than oral baclofen. Botulinum toxin injections can address focal, muscle-specific spasticity, helping to reduce tone in troublesome areas. Using these approaches alongside ongoing physical therapy supports range of motion, prevents contractures, and improves functional ability. Repeating passive range-of-motion hourly isn’t a recognized next-step strategy, and stopping therapy or letting spasticity progress would undermine goals. So, initiating intrathecal baclofen pump therapy or botulinum toxin injections with continued PT is the appropriate next step.