Disorders of Muscular Tone in Children After Acquired Brain Injury: Diagnosis, Evaluation and Therapeutic Approaches


Chiara Veredice


Gessica Della Bella
Alessandro Capuano
Francesca Meroni
Flaminia Frascarelli
Carlo Efisio Marras



Moderate to severe acquired brain injury (ABI) can result in development of movement disorders such as spasticity or dystonia, which adversely affects function and quality of life. Spasticity is a motor disorder that causes significant disability and impairs function. There are no definitive parameters that assess spasticity , anyway we are aware that spasticity evaluation is important in determining stages of recovery. It can determine treatment effectiveness as well as how treatment should proceed. Movement disorders such as dystonia are most frequently associated with lesions of the basal ganglia (44%). There is a wide consensus regarding the utility of a multidisciplinary approach in the disorder management. The aim of our session is the identification of optimal clinical practice by using the best available evidence. We will provide a panoramic review of the feasible pharmacological and surgical treatment  nowadays available in the management of the disorders. Besides we will analyze the criteria and the role of botulinum toxin (BTX) as a treatment for both spastic and dystonic muscles, and in avoiding deformity and pain. We will assess the state of the art of the management of the above mentioned disorders after ABI, and analyze the efficacy of combination of physiotherapy, casting, orthotics together with focal, systemic and surgical treatment. Recognize the prevalent movement disorder and understand the best therapeutic approach can lead to a better outcome in terms of function and quality of life.

Learning Objectives:

  1. Learn the nosological statement of the disease by choosing clinical and diagnostic tools used to assess and classify  muscular tone disorders, identifying the correct diagnostic workflow and focusing on the prevalent disorder of muscular tone in children affected with acquired brain injury.
  2. Learn the non surgical therapeutic options by choosing the pharmacological treatment according to the available therapeutic offers; accurately selecting the best candidates in terms of safety and efficacy, for the treatment with botulinum toxin; recognizing methodologies, models and algorithms for neurorehabilitation strategies even by using robot mediated therapy.
  3. Learn how to select the surgical candidates in terms of defining patients selection criteria, summarizing the main surgical approaches and managing the early and late postoperative monitoring.