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Spasticity Without the Plateau: Science, Access, and the Path Forward
In this episode of the No Plateau Podcast, host Henry Hoffman dives deep into one of the most misunderstood and impactful challenges in neurorehabilitation: spasticity. Joined by nationally recognized physiatrist and researcher Dr. Monica Verduzco-Gutierrez, the conversation goes far beyond definitions to explore how spasticity truly affects function, quality of life, access to care, and long-term outcomes for stroke and brain injury survivors.
Dr. Verduzco-Gutierrez breaks down why the classic, textbook definition of spasticity falls short in real-world practice and explains how clinicians should think about spasticity as part of a broader upper motor neuron syndrome. Together, they unpack how spasticity actually presents in daily life, how to explain it clearly to patients and caregivers, and why functional assessment matters more than a number on a scale.
The discussion walks through the full spectrum of spasticity management, from therapy and home exercise to oral medications, botulinum toxin injections, neurolysis options like phenol, alcohol, and emerging cryoneurolysis, and when surgical interventions may be appropriate. Henry and Monica also explore why spasticity treatment must be goal-driven, revisited over time, and always paired with rehabilitation rather than viewed as a one-time fix.
The episode closes with an eye-opening look at disparities in access to spasticity care, cost-effectiveness research, and why treating spasticity early and appropriately can reduce hospitalizations, complications, and overall healthcare costs. This is a must-listen for clinicians, caregivers, and survivors who want a clearer, more practical roadmap for managing spasticity well.
In This Episode
Introduction to the No Plateau Podcast (00:00)
Meet Dr. Monica Verdusco Gutierrez (00:59)
Understanding spasticity: Definitions and misconceptions (02:59)
Assessing spasticity: Tools and techniques (08:35)
Treatment options for spasticity (12:38)
Neurolysis: Phenol, alcohol, and cryo (16:23)
The importance of functional goals in spasticity management (22:43)
Introducing the AAPM&R consensus guidance (24:39)
Getting feedback from patients and therapists (28:37)
Botox and other toxin treatments (29:07)
Exploring cryotherapy for spasticity (29:57)
Disparities in access to spasticity care (31:10)
Cost efficiency in spasticity management (36:56)
Caregiver challenges in managing spasticity (42:14)
Communication between therapists and physicians (44:47)
Future directions in spasticity management (51:20)
Conclusion and final thoughts (54:51)
Our Guest
Monica Verduzco-Gutierrez, MD
Dr. Monica Verduzco-Gutierrez is a board-certified physiatrist specializing in neurorehabilitation and spasticity management. She is a Professor and Distinguished Chair of Rehabilitation Medicine at UT Health San Antonio, Medical Director of Neurorehabilitation at Warm Springs Rehabilitation Hospital, and lead author of the AAPM&R Consensus Guidance on Spasticity Assessment and Management. Dr. Verduzco-Gutierrez is widely published on spasticity, health equity, and cost-effectiveness in rehabilitation medicine.
Resources & Links
AAPM&R Consensus Guidance on Spasticity Assessment and Management (2024)
UT Health San Antonio – Department of Rehabilitation Medicine
Monica Verduzco-Gutierrez on LinkedIn
Monica Verduzco-Gutierrez UT Health
Henry Hoffman on LinkedIn
Saebo
On YouTube
On Instagram
On LinkedIn
Saebo’s Stroke Caregiver Support Group
Saebo’s Stroke Survivor Support Group
Stroke Guidelines 2023
View all episodes
By Henry Hoffman
5
44 ratings
In this episode of the No Plateau Podcast, host Henry Hoffman dives deep into one of the most misunderstood and impactful challenges in neurorehabilitation: spasticity. Joined by nationally recognized physiatrist and researcher Dr. Monica Verduzco-Gutierrez, the conversation goes far beyond definitions to explore how spasticity truly affects function, quality of life, access to care, and long-term outcomes for stroke and brain injury survivors.
Dr. Verduzco-Gutierrez breaks down why the classic, textbook definition of spasticity falls short in real-world practice and explains how clinicians should think about spasticity as part of a broader upper motor neuron syndrome. Together, they unpack how spasticity actually presents in daily life, how to explain it clearly to patients and caregivers, and why functional assessment matters more than a number on a scale.
The discussion walks through the full spectrum of spasticity management, from therapy and home exercise to oral medications, botulinum toxin injections, neurolysis options like phenol, alcohol, and emerging cryoneurolysis, and when surgical interventions may be appropriate. Henry and Monica also explore why spasticity treatment must be goal-driven, revisited over time, and always paired with rehabilitation rather than viewed as a one-time fix.
The episode closes with an eye-opening look at disparities in access to spasticity care, cost-effectiveness research, and why treating spasticity early and appropriately can reduce hospitalizations, complications, and overall healthcare costs. This is a must-listen for clinicians, caregivers, and survivors who want a clearer, more practical roadmap for managing spasticity well.
In This Episode
Introduction to the No Plateau Podcast (00:00)
Meet Dr. Monica Verdusco Gutierrez (00:59)
Understanding spasticity: Definitions and misconceptions (02:59)
Assessing spasticity: Tools and techniques (08:35)
Treatment options for spasticity (12:38)
Neurolysis: Phenol, alcohol, and cryo (16:23)
The importance of functional goals in spasticity management (22:43)
Introducing the AAPM&R consensus guidance (24:39)
Getting feedback from patients and therapists (28:37)
Botox and other toxin treatments (29:07)
Exploring cryotherapy for spasticity (29:57)
Disparities in access to spasticity care (31:10)
Cost efficiency in spasticity management (36:56)
Caregiver challenges in managing spasticity (42:14)
Communication between therapists and physicians (44:47)
Future directions in spasticity management (51:20)
Conclusion and final thoughts (54:51)
Our Guest
Monica Verduzco-Gutierrez, MD
Dr. Monica Verduzco-Gutierrez is a board-certified physiatrist specializing in neurorehabilitation and spasticity management. She is a Professor and Distinguished Chair of Rehabilitation Medicine at UT Health San Antonio, Medical Director of Neurorehabilitation at Warm Springs Rehabilitation Hospital, and lead author of the AAPM&R Consensus Guidance on Spasticity Assessment and Management. Dr. Verduzco-Gutierrez is widely published on spasticity, health equity, and cost-effectiveness in rehabilitation medicine.
Resources & Links
AAPM&R Consensus Guidance on Spasticity Assessment and Management (2024)
UT Health San Antonio – Department of Rehabilitation Medicine
Monica Verduzco-Gutierrez on LinkedIn
Monica Verduzco-Gutierrez UT Health
Henry Hoffman on LinkedIn
Saebo
On YouTube
On Instagram
On LinkedIn
Saebo’s Stroke Caregiver Support Group
Saebo’s Stroke Survivor Support Group
Stroke Guidelines 2023