Phys Med Rehabil Clin N Am
· 2026 May · PMID 42062021
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Spastic forearm, wrist, and hand deformities in isolation or collectively can markedly hinder function and/or provide challenges with hygiene. When muscle contracture is the main contributor to the spastic deformity, mus...Spastic forearm, wrist, and hand deformities in isolation or collectively can markedly hinder function and/or provide challenges with hygiene. When muscle contracture is the main contributor to the spastic deformity, muscle-based and tendon-based procedures can effectively correct the abnormal posture. Tendons from expendable muscles can be transferred to the weak or paralyzed muscle to improve the static position of the joint or to restore active function. When employed for the correct underlying pathology, muscle-based procedures can effectively correct the spastic deformity, which can lead to improved quality of life and function.
Phys Med Rehabil Clin N Am
· 2026 May · PMID 42062020
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Muscle-based procedures have been the mainstay of surgical treatment of spastic upper limb deformities, in particular when muscle contractures are a main contributor to the deformity. The type of muscle-based procedures...Muscle-based procedures have been the mainstay of surgical treatment of spastic upper limb deformities, in particular when muscle contractures are a main contributor to the deformity. The type of muscle-based procedures that are utilized to correct a spastic deformity is dependent upon the presence of volitional motor activation and the magnitude of muscle contracture. These procedures can markedly improve patient's quality of life and enhance upper limb function. However, comprehensive multidisciplinary care and establishment of shared patient-physician or caretaker-physician decision-making is integral to successful surgical outcomes.
Boissonnault È, Pick A, Pereira J
… +2 more, Li S, Winston P
Phys Med Rehabil Clin N Am
· 2026 May · PMID 42062019
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Cryoneurolysis is a minimally invasive procedure, guided by ultrasound and electrical stimulation, that uses controlled freezing to manage spasticity by inducing reversible axonotmesis. It has shown promising outcomes in...Cryoneurolysis is a minimally invasive procedure, guided by ultrasound and electrical stimulation, that uses controlled freezing to manage spasticity by inducing reversible axonotmesis. It has shown promising outcomes in adult and pediatric populations, particularly for patients unresponsive to botulinum toxin. This review highlights the mechanism of action, clinical evidence, safety profile, and cost considerations of cryoneurolysis, highlighting its role as a valuable addition to the multimodal approach to spasticity management. Further studies are needed to refine technique parameters and better understand its long-term effects.
Facciorusso S, Spina S, Cinone N
… +1 more, Santamato A
Phys Med Rehabil Clin N Am
· 2026 May · PMID 42062018
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This narrative review synthesizes current understanding of peripheral neuromodulation for spasticity. It navigates the spectrum of electrical and mechanical techniques, elucidating their operative mechanisms and clinical...This narrative review synthesizes current understanding of peripheral neuromodulation for spasticity. It navigates the spectrum of electrical and mechanical techniques, elucidating their operative mechanisms and clinical utility. The potential of peripheral neuromodulation to refine spasticity management through targeted, nonpharmacological interventions, thereby enhancing functional outcomes within neurorehabilitation, has been emphasized.
Picelli A, Di Censo R, Smania N
… +1 more, Filippetti M
Phys Med Rehabil Clin N Am
· 2026 May · PMID 42062017
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This narrative review examines the potential role of physical modalities in the multidisciplinary management of spasticity, focusing on their physiologic mechanisms, clinical efficacy, and integration with pharmacologic...This narrative review examines the potential role of physical modalities in the multidisciplinary management of spasticity, focusing on their physiologic mechanisms, clinical efficacy, and integration with pharmacologic and rehabilitative strategies. It discusses how interventions such as extracorporeal shock wave therapy, electrotherapy, heating methods (ultrasound and diathermy), and vibration therapies (focal and whole-body) target both the neural and nonneural components of spasticity by modulating neuronal excitability and improving muscle rheology. The review also highlights their synergistic effects with antispastic agents, particularly botulinum toxin type A, providing adjunctive mechanisms that can optimize therapeutic outcomes.
Phys Med Rehabil Clin N Am
· 2026 May · PMID 42062016
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The central nervous system (CNS) generates various motor functions, in part by modulating the excitability of spinal reflex pathways. When a reflex becomes not modulable or its modulation becomes impaired due to spinal c...The central nervous system (CNS) generates various motor functions, in part by modulating the excitability of spinal reflex pathways. When a reflex becomes not modulable or its modulation becomes impaired due to spinal cord lesions or other CNS diseases, it could become a part of spastic movement disorders. For the CNS with or without chronic lesions, thus, reflexes can be used as tools to probe its state. Utilizing such features of spinal reflexes, it is possible to operantly condition a reflex to improve CNS activity and resulting motor function in spastic individuals with spinal cord lesions.
Phys Med Rehabil Clin N Am
· 2026 May · PMID 42062015
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This article reviews the neuromuscular maladaptation in spastic muscles, including motor unit remodeling, muscle fiber changes, and the accumulation of hyaluronan in the extracellular matrix, and fibrosis of connective t...This article reviews the neuromuscular maladaptation in spastic muscles, including motor unit remodeling, muscle fiber changes, and the accumulation of hyaluronan in the extracellular matrix, and fibrosis of connective tissues and fascia thickening. It highlights how these neural and muscular changes interact and contribute to muscle stiffness, weakness, and contractures, limiting function and mobility. The article also examines the effects of spasticity interventions, such as botulinum toxin, phenol neurolysis, hyaluronidase, dry needling, and fasciotomy, on neuromuscular adaptations. Understanding neuromuscular maladaptation is crucial for tailoring individualized, multimodal treatment strategies that balance the reduction of spasticity.
Phys Med Rehabil Clin N Am
· 2026 May · PMID 42062014
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Chronic spasticity is a dynamic, multifactorial condition that demands continuous, personalized management. This article reviews the evolving pathophysiology of spasticity, emphasizing the interplay of neural hyperexcita...Chronic spasticity is a dynamic, multifactorial condition that demands continuous, personalized management. This article reviews the evolving pathophysiology of spasticity, emphasizing the interplay of neural hyperexcitability and structural muscle changes. Botulinum toxin type A remains a key intervention but achieves optimal outcomes only when integrated into a multidisciplinary rehabilitation framework. Evidence supports a multimodal approach and the use of adjunct therapies such as stretching, strengthening, orthoses, and task-specific training. Technological advances and goal-oriented tools further enhance long-term care. A paradigm shift is needed: from episodic treatment to chronic disease management focused on function, prevention, and quality of life.
Phys Med Rehabil Clin N Am
· 2026 May · PMID 42062013
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Disparities in spasticity care contribute to preventable morbidity and unequal rehabilitation outcomes. Structural inequities in health care access, underrepresentation in clinical trials, and limited awareness of spasti...Disparities in spasticity care contribute to preventable morbidity and unequal rehabilitation outcomes. Structural inequities in health care access, underrepresentation in clinical trials, and limited awareness of spasticity in underserved populations hinder timely intervention. This article explores systemic gaps in spasticity management and outlines strategies to promote equitable care delivery and improve long-term patient outcomes across all populations.
Phys Med Rehabil Clin N Am
· 2026 May · PMID 42062012
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Spasticity is an individual, sensory-motor experience that is correlated with nonmotor symptoms of pain, fatigue, and dysesthesia. Patients and clinicians may have different understandings of spasticity. This discrepancy...Spasticity is an individual, sensory-motor experience that is correlated with nonmotor symptoms of pain, fatigue, and dysesthesia. Patients and clinicians may have different understandings of spasticity. This discrepancy is complicated because spasticity is highly variable depending on the individual and the unique stressors in their environment. Listening to how patients explain their symptoms and what factors make their spasticity better or worse is key to effective symptom management. Good patient-clinician communication leads to applying the correct treatment of each symptom. The use of oral medications, physical therapy, botulinum toxins, intrathecal baclofen therapy, and adjunctive therapies are reported through patient experience.
Latorre J, Wilroy J, Christian V
… +1 more, Colorado B
Phys Med Rehabil Clin N Am
· 2026 Feb · PMID 41207728
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To become a Paralympian and sustain that level, effective training is particularly important. Training extends further than just improving one's physical abilities through strength and conditioning. Training the mind, im...To become a Paralympian and sustain that level, effective training is particularly important. Training extends further than just improving one's physical abilities through strength and conditioning. Training the mind, improving biomechanics, recovery, and using technology all aid in improving the athlete's overall performance. This article focuses on summarizing the current research regarding adaptive athletes while extrapolating from the able-bodied research when research is limited.
Vijayaraghavan N, Kasitinon D, Pierce C
… +1 more, Colorado B
Phys Med Rehabil Clin N Am
· 2026 Feb · PMID 41207727
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The use of ultrasound in adaptive sports has not been well studied. There is more literature for use in wheelchair athletes who suffer overuse upper extremity injuries, including shoulder and biceps tendon injuries, late...The use of ultrasound in adaptive sports has not been well studied. There is more literature for use in wheelchair athletes who suffer overuse upper extremity injuries, including shoulder and biceps tendon injuries, lateral epicondylosis, ulnar neuropathy at the elbow, and carpal tunnel syndrome. A few key lower extremity injury phenotypes have been studied with ultrasound in this population, including HO and skin complications. There are also unique applications of ultrasound, including boosting, respiratory muscle training, and evaluation of deep tissue injuries. Further ultrasound studies for adaptive athletes, particularly at the international level, would be advantageous.
Dubon ME, Chandan P, Purcell P
… +1 more, Vaughn VM
Phys Med Rehabil Clin N Am
· 2026 Feb · PMID 41207726
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We present a scoping review regarding sports-related injury patterns in athletes with intellectual disabilities. We examined studies published through February 1, 2025 that were retrieved through librarian performed lite...We present a scoping review regarding sports-related injury patterns in athletes with intellectual disabilities. We examined studies published through February 1, 2025 that were retrieved through librarian performed literature searches. The search resulted 646 articles of which 12 articles were selected. The majority of relevant studies are reports of injuries at individual Special Olympics games and do not address detailed injury specifics. Quality of data improved over time. Little literature exists investigating injury patterns in athletes with intellectual disability; however, there has been an increase in the number and quality of studies starting in 2022. Further research is recommended.
Mostoufi SA, Farkas GJ, Blauwet C
… +2 more, Dalal K, Morse LR
Phys Med Rehabil Clin N Am
· 2026 Feb · PMID 41207725
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Adaptive athletes are a high performing yet medically complex group, facing unique challenges related to bone health and energy availability. Bone health is fundamental to athletic performance, injury prevention, and lon...Adaptive athletes are a high performing yet medically complex group, facing unique challenges related to bone health and energy availability. Bone health is fundamental to athletic performance, injury prevention, and long-term physical function. However, many adaptive athletes are predisposed to compromised bone integrity due to factors such as impaired mobility, reduced mechanical loading, hormonal dysregulation, and comorbid conditions. The purpose of this article is to synthesize current evidence on bone health and energy availability in adaptive athletes, examine mechanisms linking low energy availability to bone outcomes, and propose clinical recommendations for monitoring and intervention.
Phys Med Rehabil Clin N Am
· 2026 Feb · PMID 41207724
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Adaptive and para athletes' mental health and well-being are an essential aspect of their care. These athletes deal with unique factors including lack of accessible facilities and accommodations, cost and difficulty with...Adaptive and para athletes' mental health and well-being are an essential aspect of their care. These athletes deal with unique factors including lack of accessible facilities and accommodations, cost and difficulty with adaptive sports equipment, social stigma, and medical factors including chronic pain, spasticity, bladder and bowel dysfunction, and medication usage. While screening tools for mental health symptoms are readily available and can be used among adaptive and para athletes, it is not routinely performed. Additional research and education among health care providers are needed to improve early identification and proper interventions and treatment.
Phys Med Rehabil Clin N Am
· 2026 Feb · PMID 41207722
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The periodic health evaluation (PHE) is a tool used to assess, monitor, and identify barriers to safe participation in sport. Currently, there are no standards associated with the PHE in the adaptive sport population. Th...The periodic health evaluation (PHE) is a tool used to assess, monitor, and identify barriers to safe participation in sport. Currently, there are no standards associated with the PHE in the adaptive sport population. These athletes have a higher prevalence and a wide variety of health problems while also having delayed access to appropriate health care. This article provides education and standardized considerations of the PHE for adaptive athletes. With guidance, health care providers are more prepared to perform comprehensive and clinically appropriate care to this at-risk population, while also promoting safe participation in sport for the adaptive athlete population.
Phys Med Rehabil Clin N Am
· 2026 Feb · PMID 41207721
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Adaptive sports medicine is an area of medical practice that comprises knowledge in the fundamentals of both Sports Medicine and Physical Medicine & Rehabilitation. There are elements that are specific to the diagnoses o...Adaptive sports medicine is an area of medical practice that comprises knowledge in the fundamentals of both Sports Medicine and Physical Medicine & Rehabilitation. There are elements that are specific to the diagnoses of adaptive athletes, which impact engagement and participation in physical activity and sports. A review of current literature was performed to explore and discuss the prevalence and efficacy of strategies incorporating adaptive sports and adaptive sports medicine in the curricula across a variety of professional disciplines.