Overview
Spasticity is a common and potentially disabling condition characterized by involuntary muscle overactivity, including increased tone, stiffness, spasm and impaired voluntary movement. It occurs following injury or disease affecting the brain or spinal cord and is frequently associated with conditions such as stroke, cerebral palsy, multiple sclerosis, traumatic brain injury and spinal cord injury. When unrecognized or undertreated, spasticity can lead to pain, contractures, deformity, functional decline and reduced quality of life.
Physiatrists play a central role in the assessment and longitudinal management of spasticity as part of interdisciplinary rehabilitation care teams. The American Academy of Physical Medicine and Rehabilitation (AAPM&R) recognizes spasticity as a critical area of impact for rehabilitation medicine and has launched a coordinated, multi-year effort to support evidence-based care, patient access and health system alignment.
AAPM&R Clinical Guidance on Spasticity
American Academy of Neurology(AAN): Affirmation of Value
The American Academy of Neurology (AAN) has affirmed the value of the AAPM&R consensus guidance on spasticity assessment and management as a useful educational resource for clinicians. The AAN affirmation recognizes that the guidance provides relevant and practical information to support the care of individuals with spasticity.
In May 2024, AAPM&R released consensus guidance on spasticity assessment and management, establishing a practical, evidence-informed framework for clinicians caring for patients with spasticity. The guidance was developed by a multidisciplinary Spasticity Technical Expert Panel using a structured evidence review and modified Delphi process.
Key principles emphasized within the guidance include:
• Early identification and regular reassessment of spasticity
• Use of standardized measures to evaluate spasticity and functional impact
• Goal-directed, individualized treatment planning
• Stepwise escalation of therapy based on patient goals and risks
• Integration of rehabilitative therapy as the foundation of care
Scope of Management
Effective spasticity care often requires multimodal and interdisciplinary approaches. Management strategies may be used individually or in combination and are selected based on spasticity severity, distribution, patient goals and functional impact.
Management approaches outlined in the guidance include:
• Therapeutic exercise and functional training
• Oral medications for generalized spasticity
• Local chemodenervation such as botulinum toxin injections
• Neurolytic procedures (e.g., phenol or alcohol blocks)
• Intrathecal baclofen therapy
• Selective surgical interventions for appropriately selected patients
Quality and Practice Initiatives
AAPM&R has launched a comprehensive quality and practice initiative focused on identifying gaps in spasticity care and advancing best practices nationwide. This work includes educational activities, guidance development, data synthesis and convening multidisciplinary stakeholders.
Current areas of focus include:
• Improving access to spasticity care across geographic regions
• Expanding clinician expertise and workforce capacity
• Defining and disseminating standards of care
• Supporting research and data collection to advance outcomes and equity
Reimbursement and Advocacy
AAPM&R actively advocates for appropriate coverage and reimbursement for evidence-based spasticity treatments. The Academy engages with payer organizations and Medicare Administrative Contractors to ensure that coverage policies align with current clinical standards and support patient access to care.
Recent advocacy efforts have focused on preserving access to botulinum toxin and other medically necessary interventions for individuals with spasticity by addressing proposed coverage limitations and supporting policy revisions.
Patient-Centered Care: The Spasticity Patient Journey
The AAPM&R Spasticity Patient Journey illustrates the lived experience of individuals with spasticity and highlights common challenges, decision points, and opportunities for early intervention and coordinated care. This resource promotes shared understanding among patients, caregivers, clinicians and policymakers across the continuum of care.
To access the Spasticity Patient Journey resource, please click here!
How to Use AAPM&R Spasticity Guidance
AAPM&R spasticity guidance is intended to inform—not replace—clinical judgment. Clinicians should individualize care based on patient goals, comorbidities, risk profiles and available resources. The Academy remains committed to updating guidance as evidence and clinical practice evolve.
Spasticity Webinar Series
Expand Your Knowledge Through Expert-Led Education
AAPM&R's Spasticity Webinar Series complements the AAPM&R consensus guidance on spasticity assessment and management by providing practical insights, case-based discussions, and implementation strategies from leading experts in rehabilitation medicine. The webinars are designed to help clinicians translate guidance recommendations into everyday practice and improve outcomes for individuals living with spasticity.
Whether you are new to spasticity management or looking to enhance your expertise, these on-demand educational programs offer practical tools and clinical pearls that can be immediately applied in practice.
Explore the webinar series and access available recordings below.
Additional webinars will be added throughout the remainder of 2026. Stay tuned for upcoming webinars in the AAPM&R E-Newsletters!
Related AAPM&R Resources