806 - Emerging Adjunctive Therapies for Pediatric Spasticity: A Scoping Review

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

SM

Smeet P. Madhani, DO

Resident
Mercy Fitzgerald Hospital
Philadelphia, Pennsylvania, United States
NM

Nicole Marici, DO

Resident
Mercy Fitzgerald Hospital
Philadelphia, Pennsylvania, United States

Submitter(s)

SM

Smeet P. Madhani, DO

Mercy Fitzgerald Hospital
Philadelphia, Pennsylvania, United States

Objectives: To evaluate recent evidence on novel adjunctive therapies for pediatric spasticity, particularly those used alongside standard treatments such as botulinum toxin and physical therapy. Focus areas include extracorporeal shock wave therapy (ESWT), virtual reality (VR)-assisted rehabilitation, robotic-assisted therapy, and cryoneurolysis.

Design: A scoping review was conducted of peer-reviewed studies published from January 2020 to August 2025 using PubMed, Scopus, and Web of Science. Inclusion criteria were studies involving patients under age 18 with spasticity due to cerebral palsy, acquired brain injury, or other neurologic conditions. Eligible designs included randomized trials, cohort studies, case series, and pilot studies. Data were extracted on intervention type, functional outcomes, safety, and treatment duration.

Results: Thirty-six studies met inclusion criteria. ESWT demonstrated short-term reductions in Modified Ashworth Scores (MAS) in five randomized controlled trials, with benefits lasting up to 12 weeks. VR-based interventions improved motivation and motor engagement across eight studies, and two trials reported gains in gross motor function when paired with conventional therapy. Robotic-assisted gait training led to improvements in selective motor control, balance, and walking speed in ambulatory children with cerebral palsy, supported by data from seven clinical trials. Cryoneurolysis was evaluated in three case reports and one pilot study, showing focal tone reduction and improved range of motion with minimal side effects.

Conclusions: Adjunctive therapies such as ESWT, VR-assisted rehabilitation, robotic therapy, and cryoneurolysis are gaining support as effective additions to standard pediatric spasticity management. While evidence is strongest for ESWT and robotic devices, early data for VR and cryoneurolysis are promising. Larger, longitudinal studies are needed to establish long-term efficacy and integration into care pathways.