The NeuroRehab Preceptor Program is a comprehensive CME mentoring initiative for practicing neurologists and physiatrists, as well as neurology and physiatry residents, on the management of spasticity and other conditions that result from motor activity dysfunction.

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This monograph by Katherine E. Alter, MD explores the diagnosis and management of spasticity, a serious condition once incompletely treated through surgical means and oral medications while patients advanced to severe disability. Effective management of spasticity in children often, but not always, requires a multidisciplinary approach with the team comprising a pediatrician, a parent/caregiver, and to the extent possible, the affected child. Clinicians treating childhood spasticity should be aware of the numerous tools available for objective assessment and quantification of the degree of spasticity and should understand its impact on both patients and caregivers. Topics include increasing caregiver awareness within a healthcare team approach, choosing appropriate local and systemic therapies, managing expectations for long-term treatment, and patient-specific goal setting. Although CME credit is no longer available for this program, it is available for your use as reference material.

Click here to access the monograph.

Katharine E. Alter, MD
Medical Director, Rehabilitation Programs
Mount Washington Pediatric Hospital
Senior Clinician/Scientist
Functional and Applied Biomechanics Section
Rehabilitation Medicine/NICHD
National Institutes of Health
Baltimore, Maryland

Katharine E. Alter, MD, is a pediatric and adult physiatrist practicing in the Baltimore, MD–Washington, DC, area. She is Medical Director of Rehabilitation Programs at Mt. Washington Pediatric Hospital, in Baltimore, an affiliate of Johns Hopkins University and the University of Maryland Health Systems. Dr Alter is also Senior Clinician/Scientist in Rehabilitation Medicine and Medical Director of the Functional and Applied Mechanics section in Rehabilitation Medicine and in the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health (NIH).

Dr Alter is a co-investigator on numerous protocols at the NIH, investigating spasticity, movement disorders, upper motor neuron syndromes, botulinum toxin therapy, proprioception, magnetic resonance imaging, and ultrasound imaging. She has authored numerous peer-reviewed publications related to these projects and, most recently, an atlas on the topic of ultrasound guidance for chemodenervation procedures.

Dr Alter is active in a number of community groups and national specialty organizations. She chairs the Research and Awards Committee of the American Academy of Cerebral Palsy and Developmental Medicine and serves on the Neuromuscular Ultrasound taskforce of the American Academies of Neuromuscular and Electrodiagnostic Medicine and Physical Medicine and Rehabilitation. Dr Alter is a member of the Board of Directors of the Commission for Motion Laboratory Accreditation. She is board certified by the American Boards of Pediatrics, Physical Medicine and Rehabilitation, and Electrodiagnostic Medicine and holds a subspecialty certificate in pediatric rehabilitation.


This monograph by Ib R. Odderson, MD, PhD, explores the diagnosis and management of spasticity, a serious condition once incompletely treated through surgical means and oral medications while patients advanced to severe disability. Topics include increasing caregiver awareness within a healthcare team approach, choosing appropriate local and systemic therapies, managing expectations for long-term treatment, and patient-specific goal setting. Although CME credit is no longer available for this program, it is available for your use as reference material.

Click here to access the monograph.

Ib R. Odderson, MD, PhD
Associate Professor of Rehabilitation Medicine
University of Washington
Medical Director
Rehabilitation Medicine Clinic
University of Washington Medical Center
Seattle, Washington

Ib R. Odderson, MD, PhD, is Associate Professor of Rehabilitation Medicine at the University of Washington, in Seattle, and Medical Director of the Rehabilitation Medicine Clinic at the University of Washington Medical Center.

Dr Odderson received a medical degree from Vanderbilt University, in Nashville, Tennessee, and a doctorate from Indiana University, in Bloomington. He held a visiting fellowship at the National Institute of Mental Health, in Bethesda, Maryland.

Dr Odderson helped pioneer the treatment of hyperhidrosis with botulinum toxins. He has written articles on reduction of saliva production with rimabotulinumtoxinB and served as guest editor for a journal on the use of botulinum toxins. He authored the book Botulinum Toxin Injection Guide, and his work appears in such journals as Neurorehabilitation and Neural Repair, Annals of Neurology, and Physical Medicine and Rehabilitation Clinics of North America.

Dr Odderson is a Fellow of the American Academy of Physical Medicine and Rehabilitation. He is a member of several organizations, including the American Association of Electrodiagnostic Medicine, the American Academy of Neurology, and the American Paraplegia Society. Dr Odderson has been identified as one of Seattle's top doctors in Seattle Magazine and Consumer's Checkbook several times.

Educational Compendium

Slide Library

  • Summary of NeuroRehab Preceptor Program Learning Objectives
  • Overview of spasticity, including pathophysiology and spastic paresis development
  • Clinical assessment of muscle overactivity in upper motor neuron syndrome
  • Treatment options for spasticity and muscle overactivity, including injectable medication

Differential Diagnosis for Spasticity

  • Overview of causes
  • Possible upper limb symptoms to observe and evaluate, including
    • Clenched fist; thumb-in-palm deformity; flexed wrist; flexed elbow; pronated forearm; functionally limited arm after stroke; adducted, internally rotated, flexion-restricted shoulder; intrinsic plus hand
  • Possible lower limb symptoms to observe and evaluate, including
    • Equinovarus foot, flexed hip, nonflexing hip, adducted thigh, adducted hip, stiff knee, flexed knee, valgus foot, hyperextended big toe
  • Assessment tools
    • Upper limb measures, including
      • Modified Ashworth Scale, Barthel Index, modified Frenchay Scale
    • Lower limb measures, including
      • Gait analysis

Patient Qualification and Selection

  • Comprehensive summary to assist in patient evaluation and treatment selection
  • Checklist to be filled out and submitted for each patient selected to participate in the NeuroRehab Clinical Consult Program

Therapeutic Options

  • Overview of pharmacotherapies for spasticity and muscle overactivity
    • Oral medications, including
      • Muscle relaxants, anxiolytics/benzodiazepines,
        α2-adrenergic agonists, and anticonvulsants
    • Chemodenervation
    • Physical therapy
    • Occupational therapy
    • Surgery

Suggested Reading and Resources

  • List of suggested articles and other resources to obtain additional information about spasticity, muscle overactivity, and current treatments