I have had the opportunity of witnessing the icing treatment (lowering extremity into bath/bucket full of water and icecubes) of the spastic hands or feet in adults many years ago. In nearly all cases, patients did not like this at all because it HURTS.

Of course it does not affect the spasticity at a central level.

In my opinion, this type of treatment could even harm the often fragile skin of these patients (vascular system).

I have see it do little except make the extremity extreemly cold and a little less stiff. Mobilising straight afterwards is a little easier but this effect does not last.

Reason why I have never used this measure myself.

Yes i agree with your point on the immersion method of icing. But i could see that ice stroking on muscles along their length is used as a facilitatory technique in recovery of paralysed muscles. I also agree with your opinion that the effect of ice is not long-lasting.

but maybe can this be considered in the case of flaccid muscles to regain its tone??

Hi Joshua, I can agree to you on that one, I have done the ice brushing and consider it on of the many stimuli one can give such as normal brushing, airflow, tapping and skinmassage (technique dr. Teilrich Leube).

It will have an effect on the autonomic nerve system, and a (as far as I am informed never studied effect) on the CNS. The recovery of paralysed muscles is dependent of the damage and recovery of the nervous sytem involved.

Flaccid muscles regaining tone? I would say we need to take into consideration the overall (general) tone of the person involved and see what exercise can do to help regain 'tone' more than any other stimuli.

Hi Esther, i am also sure that ice is one of the stimuli that can be used. The reason behind this question is that if ice could have an effect (temporary) on the paralysed muscles, then we need to take account on the environment in which we are treating that kind of patient, isnt it?? i mean that what if the patient being treated in an air-conditioned room which is too much chill and that it affects their motor performance..

Hi Joshua,

I have worked in various countries and agree that working in an airconditioned room is not always comfortable for the patient nor therapist. People welcome the ice brushing in the heat. But if it is more/less efficient than in a room that is not airconditioned I cannot say.

Heat and cold effects motor performance and makes exercising strenious. In the clinic we observe that the heat can have a negative effect on the patient's vascular and pulmonary systems. Especially with the elderly and very ill patients of all ages. I am very aware that the climate (environment) has to be taken into consideration.

Years ago, I was introduced to the use of ice blankets rather than immersion for controlling hypertonicity in spinal cord injured patients. Since that time I have used it extensively for patients with a range of CNS conditions and hypertonicity who do not respond to manual interventions. Avoiding the hands and feet makes the intervention more targeted and less noxious. Commercially available cryotherapy pads do not seem to get cold enough or maintain their temperature. For that reason I make my own ice blankets by either one of two methods: layering of treatment towels with slushy ice in an insulted cooler for use throughout the day or by making large plastic bags using a 1:2 mixture of rubbing alcohol and water. My understanding is that by cooling the targeted nerve fibers, muscle spindle activity is diminished. The desired result is lower resting tone. Typically 15-20 min is required. As Joshua suggested, stroking with an ice cup or stick can be used to facilitate improved tone.

See also the review by Smania et al. (2010; Rehabilitation procedures in the management of spasticity.) for some (very limited) evidences and rationale concerning cryotherapy and other alternative procedures in spasticity.