title: Breakthroughs in the spasticity management: Are non-pharmacological treatments the future?
abstract: The present paper aims at providing an objective narrative review of the existing non-pharmacological treatments for spasticity. Whereas pharmacologic and conventional physiotherapy approaches result well effective in managing spasticity due to stroke, multiple sclerosis, traumatic brain injury, cerebral palsy and incomplete spinal cord injury, the real usefulness of the non-pharmacological ones is still debated. We performed a narrative literature review of the contribution of non-pharmacological treatments to spasticity management, focusing on the role of non-invasive neurostimulation protocols (NINM). Spasticity therapeutic options available to the physicians include various pharmacological and non-pharmacological approaches (including NINM and vibration therapy), aimed at achieving functional goals for patients and their caregivers. A successful treatment of spasticity depends on a clear comprehension of the underlying pathophysiology, the natural history, and the impact on patient's performances. Even though further studies aimed at validating non-pharmacological treatments for spasticity should be fostered, there is growing evidence supporting the usefulness of non-pharmacologic approaches in significantly helping conventional treatments (physiotherapy and drugs) to reduce spasticity and improving patient's quality of life. Hence, non-pharmacological treatments should be considered as a crucial part of an effective management of spasticity.
authors.affiliation: IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Naro
authors.affiliation: IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Leo
authors.affiliation: IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy.
authors.forename: Margherita
authors.initials: M
authors.lastname: Russo
authors.affiliation: Stroke Unit, University of Messina, Italy.
authors.forename: Carmela
authors.initials: C
authors.lastname: Casella
authors.affiliation: IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Buda
authors.affiliation: IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy.
authors.forename: Aurelio
authors.initials: A
authors.lastname: Crespantini
authors.affiliation: IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Porcari
authors.affiliation: IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Carioti
authors.affiliation: IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy.
authors.forename: Luana
authors.initials: L
authors.lastname: Billeri
authors.affiliation: IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Bramanti
authors.affiliation: IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy.
authors.forename: Placido
authors.initials: P
authors.lastname: Bramanti
authors.affiliation: IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy. Electronic address: salbro77@tiscali.it.
authors.forename: Rocco Salvatore
authors.initials: RS
authors.lastname: Calabrò
mesh_terms: D002547:Cerebral Palsy / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D019468:Disease Management; D004599:Electric Stimulation Therapy / Q000639:trends; D005544:Forecasting; D019220:High-Energy Shock Waves / Q000627:therapeutic use; D006801:Humans; D009103:Multiple Sclerosis / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D009128:Muscle Spasticity / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D011788:Quality of Life; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D016896:Treatment Outcome; D014732:Vibration / Q000627:therapeutic use
keywords: Multiple sclerosis; Repetitive transcranial magnetic stimulation; Spinal cord injury; Stroke; Transcranial direct current stimulation