This topic is quite controversal. It is also highly complex. The latest evidence to arise from randomised controled trials indicate that spasticity in itself is a problem encounterd in neurological patients it has little direct correlation to functional outcome. Individuals can have spactisity of a high degree but goot functional outcome. I guess what I am trying to say is that at this point the main thing you need to concentrate on in gaining strength in the affected area. Weakness is the main clinical sign which is correlated strongly to functional outcome. Individuals with spactisity MAY be prone to develop shorter muscles due to positioning and then it is very important to maintain muscle length but please do not think that a spastic or tight muscle is a strong one. There is much eveidence out there to refute this.

Our departments approach is as follows.
1) Activate the muscle ASAP and train into function
2) Maintain muscle length especially in those muscles prone to shortening due to prolonged positioning from immobility.
3) Utilise appropriate drugs to assist in the decreasing of tone.
4) Functional Electircal stimulation can assist in improving muscle activation
5) EMG or biofeedback may assist in teaching the patient to relax muscle and activate others.

Problems may arise in the long term patient with minimal muscle return mostly associated with prolonged positioning. To this continued splinting, positioning, stretching, drugs/surgery may be of benefit.

There is very little evidence to suggest that seating positions will decresae spasticity. Active work on trunkal control and better body positions to allow for improved biomechanical posion in sitting for reaching or standing tasks would be the main benefit. Also prolonged stretching has been found to do little to reduce spasticity via cortical inputing rather it does maintain the muscle length. Short muscles are more difficult to activate throughout range and the antagonists need greater ability to work agains a SHORT muscle.

I am sorry this a very difficult to fully explain. YOu would benefit from doing a search via Cochrane/PEdro/Medline for greater depth of information.

Hope this is of some help