Body
Spasticity is a term used to describe abnormal involuntary tightening of muscles that either occurs spontaneously or when the body is stimulated in certain ways (for example, when a joint is moved). Spasticity may be seen in association with rapid repetitive muscle spasms, called clonus. Clonus is often found at the ankle, but may also occur at other joints in the body.
Causes
Spasticity of a muscle occurs after an injury or damage to the brain or spinal cord. Nerves signal to muscles are altered, causing muscles to tighten voluntarily. Spasticity is often not seen immediately after an injury, but may become gradually worse weeks to months following the event. Conditions that commonly lead to spasticity include strokes, cerebral palsy, spinal cord injuries, traumatic brain injuries and multiple sclerosis.
Several things can cause spasticity to worsen:
- Rapidly moving a joint
- Sensory stimulation (such as pressure or touch, particularly when this is painful)
- Medical problems such as pain or skin breakdown (pressure sore)
- Infections of the bladder or kidney
- Constipation
- Restrictive or tight clothing
- Certain body positions, e.g. sitting, lying in bed, walking or other activities may affect how tight a muscle becomes
- Fatigue
- Certain times of the day or night.
All these factors should be considered and checked if someone experiences a sudden increase in their spasticity. Patients also often report they are worse when the environment is cold.
Consequences of spasticity
Spasticity may be mild and cause only slight muscle stiffness. If it becomes more severe, the stiffness may lead to muscle tendon and joint shortening, called contracture. The tightening may also be painful.
Involuntary tightening can be reduced with medicines; however, a fixed contracture, which occurs when the muscle and the other structure become permanently short, will not be helped by the anti-spasticity medicine. Currently, this can only be treated by stretching, splinting, serial casting (progressive casts that gradually stretch out the muscle) or surgery. Spasticity medications may be used with these treatments to either make them more comfortable or more effective.
Spasticity and contractures may impact a person’s ability to do daily activities such as dressing, eating, toileting and grooming. Severe tightness in the armpit, groin, or hand can cause problems for hygiene and can lead to skin breakdown. In the upper body or leg, spasticity can affect sitting, transfers and walking.
Sometimes, however, spasticity is helpful. For example, some people are able to trigger a spasm to help roll over; or leg tightness can help someone stand when leg muscles are weak. These aspects of spasticity need to be considered when spasticity is treated
Treatments
Spasticity does not always need to be treated. It is best to consult with a medical professional who is familiar with spasticity before deciding on treatment.
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Stretching is an important part of any program to help prevent contracture development.
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Splinting can be used in addition to stretching to help maintain joint position.
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Medications that relax the muscles may also be tried. These can be given orally, injected into muscles or given through a pump into the space around the spine that contains the spinal fluid. Some patients with severe spasticity may need to be on multiple medicines, or may need to use oral medicines in combination with muscle or nerve injections, called chemodenervation (botulinum toxin or phenol injections).
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For some types of spasticity, surgery may also be done.
With severe spasticity, a treatment team may be needed to assess the best methods for intervention. This team of rehabilitation professionals usually includes a physical therapist, occupational therapist, speech therapist, rehabilitation engineer, nurse and physiatrist (rehabilitation doctor). A neurosurgeon or orthopedic surgeon may be involved, particularly if surgery is anticipated. Some centers have spasticity clinics where patients may be seen and assessed by these multiple professionals.
References
Brashear, Allison and Elovic, Elie (2010). Spasticity: Diagnosis and Management. Demos Medical Publishing: New York, New York.
Stevenson, Valerie L. and Jarrett, Louise Eds. (2006). Spasticity Management: A Practical Multidisciplinary Guide. Informa Healthcare: England.
Keywords: Spasticity, Botox, Myobloc, Chemodenervation, Intrathecal Baclofen
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