The Hypertonicity CCS Center at Miller Children’s provides specialty care for infants, children and adolescents who have developed spasticity from injuries to the brain and spinal cord and suffer from abnormal development of the brain. Many children seen in this center have cerebral palsy, spasticity in one or more extremities, brain injury and Rett’s Syndrome. The hypertonicity specialized care team also works closely with other pediatric specialists if consultation is needed.

Treatment & Interventional Therapy

The most common types of treatments for children in the Hypertonicity Center are oral medications, Botox® or Myobloc® injections, Phenol motor block injections, Intrathecal Baclofen pump or transfers (with a referral to Orthopedics), serial casting and orthotic management. The Hypertonicity team meets to review clinical cases each morning, and keep the collaboration going during each appointment, to provide the highest quality of care to each individual.

Botox® and Myobloc® Injections

When injected into a child’s muscles, Botox® and Myobloc® have a local effect on the muscle, which blocks transmission between the nerve endings and muscle fibers around the injection site to cause weakness of the nearby muscle. Myobloc® and Botox® can be safely and painlessly injected directly in a specific muscle to relax that muscle to temporarily stop spasms.

Intrathecal Baclofen Pump

Baclofen is a muscle relaxant medicine used to decrease spasticity related to multiple sclerosis, spinal cord injuries and other neurological diseases. The Baclofen pump system delivers the medicine directly into the spinal fluid, through a pump connected to a catheter that is surgically placed under the skin of the abdomen close to the waistline. The pump stores and releases the prescribed amount of medicine with a programmable system. Using this pump allows physiatrists the ability to adjust the dose, rate and timing of when medicine is administered.When spasticity is present, an injection of phenol to peripheral nerves or motor block areas can slightly damage the nerves or motor areas in order to relieve spasticity.

Phenol Motor Block Injections

When spasticity is present, an injection of phenol to peripheral nerves or motor block areas can slightly damage the nerves or motor areas in order to relieve spasticity.

Condition Management

The Hypertonicity care team offers an interdisciplinary approach to medical care, including evaluation, consultation, treatment and parental education. The Hypertonicity Center collaborates with community agencies to provide splints and braces, as well as appropriate referrals, so patients have the necessary tools to recover.

Follow-Up Care

Each patient has routine follow-up visits anywhere from every four - six weeks, to every six months, to ensure the individual treatment received is working and managed appropriately. Parents are given instructions to take home so they know what to be aware of with their child after treatment. The Hypertonicity Center care team collaborates with primary physicians and schools to ensure that a child’s condition is being managed appropriately and their treatment is progressing even when they are away from the hospital.

Approved CCS Center

The Hypertonicity Center at Miller Children’s is a California Children’s Services (CCS) approved Special Care Center (SCC). This means a specially designated multi-disciplinary care team is responsible for all care coordination and case management of a patient in this program. Patients typically qualify for the Hypertonicity CCS Special Care Center by medical diagnosis, complexity of their disease and financial status.  The Hypertonicity Center also accepts most other private insurance providers.  Thursdays are the primary CCS visit day and sometimes on Mondays. All other insurance providers can be seen on Mondays.

Your Care Team

A pediatric physiatrist is a specialized pediatric doctor of rehabilitation medicine who specializes in the comprehensive management of patients with impairments and disabilities arising from neuromuscular, musculoskeletal and vascular disorders.

Board-Certified Pediatric Physiatrists

Other Team Members

Additional Members of the Hypertonicity Care Team
  • Nurse Practitioner
    A nurse practitioner is a registered nurse with special training for providing primary health care, including many tasks customarily performed by a physician.
  • Clinical Nurse Specialist
    A clinical nurse specialist is responsible for arranging authorizations for procedures, appointments, special tests and studies and communication among the child, family, school, primary care physician, team and others involved in the care of the child. The nurse specialist also assists the child and family in obtaining medical supplies, laboratory appointments and other care as needed.
  • Occupational Therapist
    Occupational therapists assess functioning in activities of everyday living, including dressing, bathing, grooming and writing, that are essential for independent living.
  • Physical Therapist
    Physical therapists are health care professionals concerned with the prevention, treatment and management of movement disorders arising from conditions and diseases occurring throughout the child’s growth. PTs work to help a child reach their highest level of physical function.
  • Clinical Social Worker
    Social workers help provide referrals to a broad range of community-based agencies and organizations to assist the child and family in obtaining supportive care and assistance. The social worker also is available to provide crisis counseling, individual and family counseling.