Chronic Spasticity Care

This article redefines spasticity as a dynamic, chronic neurologic condition requiring long-term, individualized, and multidisciplinary management. Spasticity is common in stroke, MS, CP, and SCI, where it contributes to disability, functional limitations, and reduced quality of life. Over time, spasticity evolves from a purely neural to a mixed neural-muscular presentation, leading to irreversible morphostructural changes, such as muscle atrophy, fibrosis, and joint contractures. These changes necessitate proactive care strategies that include both pharmacologic and rehabilitative interventions. BoNT-A is a cornerstone treatment, offering functional and symptomatic benefits when administered in a goal-oriented and cyclic manner. However, its effects are maximized only within a multimodal rehabilitation framework. Integrated therapies-such as stretching, strengthening, task-specific training, orthoses, neuromuscular stimulation, and robotics-amplify neuroplasticity and mitigate mechanical limitations. Modern care also embraces digital health, biomarker monitoring, and emerging technologies to personalize interventions and support longterm functional maintenance. The article emphasizes the need for a paradigm shift from episodic to continuous care, aligning spasticity management with models of chronic disease.