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Spastic hemiplegia, often resulting from conditions like stroke or cerebral palsy, presents a significant challenge for occupational therapy practitioners. Characterized by increased muscle tone and involuntary spasms, spasticity can hinder movement and function. Here, we explore evidence-based strategies that have shown efficacy in reducing spasticity and improving patient outcomes.

1. Deep Breathing

Deep breathing exercises are foundational in managing spasticity. Studies indicate that controlled breathing can reduce sympathetic nervous system activity, promoting relaxation and decreasing muscle tone. Incorporating diaphragmatic breathing into therapy sessions can help patients achieve a state of calm, aiding in the reduction of spasticity.

2. Deep Tendon Compression

Deep tendon compression is a proprioceptive technique that can help reduce spasticity. Applying firm, sustained pressure on tendons can stimulate the Golgi tendon organs, which play a role in muscle relaxation. This method can be particularly effective when combined with other inhibitory techniques.

3. Weight-Bearing Activities

Weight-bearing activities are crucial for promoting muscle relaxation and normalizing tone. Research shows that weight-bearing can improve proprioception and reduce spasticity through sustained pressure and joint alignment. Activities like standing or modified push-ups can be beneficial.

4. Slow Elongated Stretch

Slow, prolonged stretching of spastic muscles is effective in reducing muscle tone. Studies suggest that maintaining a stretch for at least one minute can decrease muscle excitability and spasticity. Integrating these stretches into daily routines can significantly improve flexibility and movement.

5. Sensory Stimulation

Sensory stimulation, such as tactile or thermal input, can modulate spasticity by altering sensory pathways. Evidence supports the use of various sensory modalities to inhibit hypertonic muscles. Practitioners can utilize techniques like ice packs or gentle massage to achieve these effects.

6. Neurodevelopmental Treatment (NDT)

Neurodevelopmental treatment focuses on normalizing movement patterns and muscle tone. NDT principles involve facilitating proper movement while inhibiting abnormal patterns. Research shows NDT can effectively reduce spasticity and improve functional outcomes in patients with neurological impairments.

NDT continues to be researched - it has not been 'proven ineffective' despite many professors and clinicians alluding to this misconception. It is ongoing. 

• Pathak A, Gyanpuri V, Dev P, Dhiman NR. The Bobath Concept (NDT) as rehabilitation in stroke patients: A systematic review. J Family Med Prim Care. 2021 Nov;10(11):3983-3990. doi: 10.4103/jfmpc.jfmpc_528_21. Epub 2021 Nov 29. PMID: 35136756; PMCID: PMC8797128
• Güçlü Gündüz A, Yazıcı G, Özkul Ç, Küçük H, Batur Çağlayan HZ, Nazlıel B. The effects of early neurodevelopmental Bobath approach and mobilization on quadriceps muscle thickness in stroke patients. Turk J Med Sci. 2019 Feb 11;49(1):318-326. doi: 10.3906/sag-1808-83. PMID: 30761855; PMCID: PMC7350825.
• Addini, R. A. F., & Sutejo, M. N. (2023). Effectiveness of Neurodevelopmental Treatment to Improve Motor Function in Children with Developmental Disorders: Meta-Analysis. Physiotherapy and Physical Rehabilitation Journal, 2(2), 25-34.
• Systematic Studies from 2020 and 2021 were released like 'Pathak, A., Gyanpuri, V., Dev, P., & Dhiman, N. (2021) which alluded to inconclusive evidence to determine effectiveness of the Bobath approach for the movement rehabilitation of stroke patients. They stated further research is needed. I say this to caution therapists against dismissing methodology after reports like this as it could be the result of poorly designed studies or little interest in pursuing studies that investigate effectiveness of it. This is not just regarding NDT, but regarding all methodologies used in neurological rehabilitation. Always keep an open mind and understand research is a slow journey saturated in bias. 

7. Slow and Methodical Movements

Performing movements slowly and methodically helps prevent sudden increases in muscle tone. Controlled, deliberate actions allow patients to maintain better control over their movements and reduce the risk of triggering spastic responses. Practitioners should emphasize slow, purposeful movements during therapy.

8. Prolonged Stretching

Prolonged stretching involves holding a muscle in a lengthened position for extended periods. This technique can reduce spasticity by decreasing muscle spindle activity. It is particularly useful for patients with severe spasticity and can be combined with splinting or casting.

9. Visual Biofeedback

Visual biofeedback uses real-time feedback to help patients understand and control their movements. Studies indicate that visual feedback can enhance motor learning and reduce spasticity. Using mirrors or video recordings, practitioners can provide patients with visual cues to improve their movement patterns.

10. Relaxation Techniques

Relaxation techniques, including guided imagery and progressive muscle relaxation, can effectively reduce spasticity. These methods help decrease overall muscle tension and promote a state of relaxation. Integrating relaxation exercises into therapy sessions can improve patient comfort and reduce spastic episodes.