Spasticity – what you need to know

Eleonora Bradaschia tells us how a two-day masterclass will shed light on this syndrome affecting patients with long term neurological conditions.

Please can you introduce yourself and your role?

My name is Eleonora Bradaschia, I am a Consultant in Rehabilitation Medicine. I have been working in spasticity for more than 20 years.

I trained as a rehabilitation medicine consultant in Italy and have been working within the Neurorehabilitation service for King’s College Hospital NHS Foundation Trust (NHS FT) since 2012. I have supported the development of the service - leading the Multidisciplinary Team (MDT) management of patients admitted to the level 1 unit. I have also been involved in the opening of the level 2b Specialist Rehabilitation unit in 2016 and the Trauma Rehabilitation Service in 2020.

I have been leading the development of the Spasticity Service across King’s College Hospital NHS FT. The King’s Spasticity Service, with its strong MDT and holistic approach, is now playing a leadership role within the region.

I began chairing, in partnership with Guy’s and St Thomas’ NHS FT, the South East London spasticity project group. This brings together a group of clinicians across south east London NHS services - including community and hospital based - to identify gaps and inequalities in spasticity management in south east London. We are proposing a shared pathway that meets full demand, offers equitable access to treatments, and meets best practice and National guidelines through a hub and spoke model, where King’s College Hospital is proposed to act as the central hub.

I have been covering the role of Spasticity Lead at King’s College Hospital NHS FT since 2016. Since the beginning of 2022, I have been mostly dedicated to the spasticity service - delivering and coordinating the several pathways and training healthcare professionals to maintain a highly skilled team.

What is spasticity and how does it affect patients? 

Spasticity is a syndrome frequently affecting patients with long term neurological conditions affecting their brain or spinal cord. It presents as muscle involuntary overactivity - such as stiffness and spasms - and can impact in different ways on patients’ quality of life.

Spasticity can cause:

• Pain and discomfort;
• difficulty in completing tasks with an affected arm;
• difficulties in mobilising, with risk of falls;
• sleep disturbance;
• difficulty in personal care;
• fatigue;
• body dysmorphia;
• mental health issues. 

If left untreated it can lead to serious complications such as infections, pressure sores as well as chronic pain and discomfort. This can lead to hospital admissions, which could have been prevented with appropriate management.

What services and expertise does the Spasticity Multidisciplinary Team offer both to patients and system partners?

The Spasticity Service at King’s College Hospital NHS FT offers a multidisciplinary service composed of a rehabilitation doctor, specialist nurse, physiotherapist, and occupational therapist.

The service includes outpatient face to face and telephone clinics for a holistic approach to spasticity management, with the most specialist medical treatment available such as botulinum toxin and intrathecal baclofen as well as liaison with the orthopaedic service for functional surgeries. Therapy reviews and advice, along with adjunct treatments such as specialist splinting and liaison with orthotics, are offered on site. We can also offer referrals to external agencies for more local access or services not available on site such as FES (Functional Electrical Stimulation) and intensive upper limb programme.

We have been establishing effective links with community services and other tertiary services to ensure continuity of care in the delivery of each patient’s management plan.

The spasticity service at King’s College Hospital NHS FT also offers inpatient pathways. MDT management of spasticity of any complexity is part of day-to-day care of patients admitted to the neurorehabilitation wards at Orpington Hospital.

We have established an in-reach service to both Trust acute sites to support teams managing patients with neurological conditions developing spasticity or admitted due to complications of severe spasticity. We offer a MDT review suggesting medical and therapy treatment resulting in co-ordinated care with the treating team and we support liaison with community services at the time of discharge.

We are developing training and education as well.

What can attendees of the two day masterclass expect?

The event is designed for clinicians looking after patients with long term neurological conditions, who are interested in developing a local spasticity service or their own skills in managing spasticity. It is an opportunity to share best practice and raise awareness of community services, including among primary care, for implementing coordinated patient care and improving referral pathways.

Sign up for the spasticity masterclass here.

Find out more about the work of KHP Neurosciences.