Terms used in this guideline

Botulinum toxin type A

A neurotoxin produced by the bacterium Clostridium botulinum that blocks neurotransmitter release at peripheral cholinergic nerve terminals. Injection into a muscle reduces spasticity.

Constraint-induced movement therapy

An approach to physical therapy in which an unaffected arm is temporarily restrained to encourage use of the other arm.

Continuous pump-administered intrathecal baclofen treatment

Direct administration of baclofen into the fluid-filled space around the spinal cord (the intrathecal space) using a catheter and infusion pump. The pump is implanted in the abdominal cavity and allows a continual controlled delivery of baclofen adjusted according to need.

Contracture

Shortening of muscle tendons, ligaments and soft tissues resulting in a limitation of joint movement. Usually, muscle shortening is the primary abnormality, but prolonged immobility or scarring may also contribute.

Dystonia

Involuntary, sustained, or intermittent muscle contractions that cause twitching and repetitive movements, abnormal postures or both.

Equinus deformity

Abnormal ankle plantarflexion (movement of the foot at the ankle joint in a downward direction). This can, for example, result in the child or young person walking on tiptoe.

Fine motor function

The ability to use small muscle groups, often in coordination with the eyes, to perform precision activities such as writing or fastening buttons.

Focal dystonia

Dystonia involving a specific muscle or group of muscles.

Focal spasticity

Spasticity involving a specific muscle or group of muscles.

Function

The ability to perform normal activities or actions. Such function may be impaired by spasticity and associated motor disorders and by the complications of spasticity.

Gait analysis

A detailed approach to analysing the component phases of walking using instrumentation or video analysis in addition to clinical observation. This is undertaken to evaluate a child or young person's ability and style of walking and to plan or assess treatment.

Gross motor function

The ability to use large muscle groups to perform body movements such as sitting, standing, walking and running.

Gross Motor Function Classification System

A 5-point scale that describes gross motor function: level I, walks without restrictions; level II, walks without assistive devices; level III, walks with assistive devices; level IV, has limited self-mobility; level V, has severely limited self-mobility even with assistive devices.

Hip migration

Movement of the top of the thigh bone that connects with the pelvis (the femoral head) from its normal position in the socket joint of the hip (the acetabulum). This movement is often measured by reporting the degree of displacement seen on X-ray (known as the hip migration percentage).

Intrathecal baclofen testing

Direct injection of baclofen into the fluid-filled space around the spinal cord (the intrathecal space) using a lumbar puncture needle or a temporary spinal catheter in order to assess the likely response to continuous pump-administered baclofen treatment.

Kyphosis

Abnormal curvature of the spine when viewed from the side of the body that results in a hunched or slouching position.

Low-load active stretching

A physical therapy intervention in which the child or young person actively stretches their muscles with the aim of increasing range of movement.

Low-load passive stretching

A physical therapy intervention involving sustained stretching using positioning with equipment, orthoses or serial casting.

Muscle tone

The normal state of continuous passive partial contraction in a resting muscle. Muscle tone is important in maintaining posture. Increased muscle tone (hypertonia) is associated with an abnormal resistance to passive stretch, while reduced muscle tone (hypotonia) is associated with floppiness of the limbs or trunk and poor posture.

Network of care

Linked groups of healthcare professionals and organisations working in an agreed and coordinated manner to deliver a clinical service. A network is not constrained by existing professional, organisational or institutional boundaries.

Network team

A multidisciplinary group of healthcare and other professionals working in a network of care to deliver a clinical service.

Orthosis (plural, orthoses)

An artificial device or appliance used to support, align, prevent, or correct deformities or to improve musculoskeletal function.

Passive range of movement

The degree of motion through which a joint can be moved by an outside force without active participation by the child or young person themself (for example, movement by another person).

Range of movement

The range of motion, usually measured in degrees, through which a joint can move.

Scoliosis

An abnormal lateral curvature of the spine viewed from in front of or behind the child or young person.

Secondary complication of spasticity

An adverse effect on musculoskeletal structure that occurs as a result of spasticity (for example, a contracture or abnormal torsion).

Secondary consequence of spasticity

Any effect experienced by a child or young person as a result of spasticity. This may be symptomatic (for example, pain or difficulty walking) or a complication affecting the structure of the musculoskeletal system (see secondary complication of spasticity).

Selective dorsal rhizotomy

A neurosurgical procedure in which some of the sensory nerves that contribute to spasticity in the lower limb are cut at the point where they enter the spinal cord.

Serial casting

The successive use of casts with the aim of progressively lengthening muscles and other non-bony tissues such as ligaments and tendons thereby reducing the effect of contractures by passive stretching to gradually improve the range of movement.

Spasticity

A specific form of increased muscle tone (hypertonia) in which one or both of the following are present:

  • the resistance to externally imposed movement increases with increasing speed of stretch and varies with the direction of joint movement

  • the resistance to externally imposed movement increases rapidly beyond a threshold speed or joint angle.

Spinal fusion

A surgical procedure where two or more vertebrae are joined to prevent movement between them.

Task-focused active-use therapy

A physiotherapy technique where a specific goal is identified and the child or young person carries out exercises or activities using the affected limb or limbs to improve their performance.

  • National Institute for Health and Care Excellence (NICE)