1000 Section - Management of Spasticity in Para-Athletes: A Case Series

Spasticity is a motor disorder characterized by a velocity-dependent increase in muscle tone resulting from central nervous system injury and is frequently observed in individuals with spinal cord injury, cerebral palsy, and stroke. These conditions are highly prevalent among para-athletes, making spasticity a relevant factor influencing both functionality and sports performance. Although traditionally regarded as a limiting condition, spasticity may exert variable effects depending on its severity, muscle distribution, and the specific functional and sport-related demands of each athlete.

Design:

This study presents a retrospective case series evaluating individualized spasticity management strategies in para-athletes, with particular emphasis on the use of botulinum toxin associated with adjuvant oral antispastic therapy. Six adult athletes with spastic tetraparesis secondary to spinal cord injury (AIS A–C; neurological levels C6–C8) were included. Most participants received oral antispastic agents, predominantly baclofen, and all underwent targeted botulinum toxin injections tailored to clinical presentation and functional goals.

Muscle targets included the rectus femoris and hamstrings in the lower limbs and the biceps brachii and intrinsic hand muscles in the upper limbs, with doses adjusted according to the extent of involvement. Outcomes were assessed using the Goal Attainment Scale (GAS), allowing individualized evaluation of functional objectives.

Results:

Results demonstrated meaningful improvements in positioning, mobility, and self-care, with most goals achieved or exceeded expectations. Improvements were particularly evident in wheelchair positioning, transfers, knee extension, and dressing activities. Quality-of-life outcomes showed more variable responses.

Conclusion:

These findings highlight the relevance of individualized spasticity management in para-sport contexts. Carefully planned botulinum toxin use, integrated with rehabilitation and sport-specific training, can enhance functional performance while preserving strength and stability. Such an approach supports not only athletic performance but also competitive equity in adapted sports. Further prospective studies with larger samples are warranted to better define dose–response relationships and long-term effects in high-performance para-athletes.