• Spasticity

    Definition

    Spasticity is the involuntary contraction, stiffening, or tightening of muscles.
    Contraction of the Hand
    IMAGE
    Copyright © Nucleus Medical Media, Inc.

    Causes

    The amount of tone or tension in a muscle is determined by signals from the brain that travel through the spinal cord. Injury to tissue in the brain or spinal cord can cause a disruption of these signals which leads to the abnormal contractions of the muscle.

    Risk Factors

    Damage to specific areas of the brain or spinal cord increases the risk for spasticity. Conditions most often associated with this type of damage include:

    Symptoms

    Spasticity can range from a feeling of tightness in a muscle to severe muscle spasms or contractures. Depending on the severity of the spasticity and the location of the affected muscle other symptoms may include:
    • Stiffness in muscles that can make fine movements difficult
    • Muscle fatigue
    • Pain in the affected muscles
    • Difficulty controlling muscles needed to move and/or communicate
    • Involuntary movement of limbs or joints
    • Difficulty completing daily tasks
    Over time, spasticity can cause:
    • Deformity of bones, the spine, joints and muscle
    • Impaired muscle growth in children

    Diagnosis

    You will be asked about your symptoms and medical history. A physical exam will be done, paying particular attention to your ability to move. Spasticity can be identified through a physical exam. The cause may be apparent through a review of medical history, but further testing may be needed.

    Treatment

    Talk with your doctor about the best treatment plan for you. Treatment goals include:
    • Relieving muscle spasms
    • Reducing pain
    • Improving the ability to move and attend to personal hygiene and activities of daily living
    • Improving motor function, such as the ability to grasp, move, and release objects
    • Enabling normal muscle growth in children
    • Preventing complications like deformities, constipation, or bed sores
    Treatment options include any or all of:

    Rehabilitation Therapy

    Physical and occupational therapies will work to decrease discomfort by decreasing the tension in the muscle. This may be done with gentle stretches, cold packs, or electrical stimulation.
    The therapists will also work to improve the function of the muscle. This may include:
    • Stretching and strengthening exercises
    • Temporary braces or other supportive devices
    • Increasing range of motion by moving the spastic areas
    • Improving coordination or learning new methods or daily activities

    Medication

    Medications may be recommended for spasticity that interferes with daily activities. Options include:
    Medications may be recommended for spasticity that interferes with daily activities. Options include:
    • Oral medication—may be a combination of medication, may have a range of side effects
    • Implanted medication pump—can deliver medication called baclofen directly to the spinal column, with fewer side effects than oral medication
    • Botulinum toxin injection—may relax overactive muscles for a few months at a time

    Herbals

    In recent years, some states have approved the use of medical marijuana for certain conditions. Some studies support the use of medical marijuana for spasticity. Talk to your doctor about whether this treatment option is right for you and if it is legally available where you live.

    Surgery

    Surgery is effective for a limited number of people with spasticity. It may be recommended for severe spasticity that interferes with function or positioning.
    The surgery involves cutting the nerve that sends sensory messages from the muscles to the spinal cord. It may help decrease the intensity of muscle stiffness and spasm.

    Prevention

    Spasticity is usually the result of an accident or the progression of an illness. There are no general prevention steps.

    RESOURCES

    American Association of Neurological Surgeons http://www.aans.org

    Christopher and Dana Reeve Foundation https://www.christopherreeve.org

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca

    Canadian Neurological Sciences Federation http://www.cnsfederation.org

    References

    Kaku M, Simpson DM. Spotlight on botulinum toxin and its potential in the treatment of stroke related spasticity. Drug Des Devel Ther. 2016:10:1085-99.

    Spasticity. American Association of Neurological Surgeons website. Available at: http://www.aans.org/Patient%20Information/Conditions%20and%20Treatments/Spasticity.aspx. Accessed May 11, 2016.

    Spasticity. American Stroke Association. Available at: http://www.strokeassociation.org/STROKEORG/LifeAfterStroke/RegainingIndependence/PhysicalChallenges/Spasticity%5FUCM%5F309770%5FArticle.jsp#.VzOadU2FPIU. Updated March 5, 2015. Accessed May 11, 2016.

    Spasticity. Christopher and Dana Reeve Foundation website. Available at: https://www.christopherreeve.org/living-with-paralysis/health/secondary-conditions/spasticity. Accessed May 11, 2016.

    Spasticity. National Multiple Sclerosis Society website. Available at: http://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Spasticity. Accessed May 11, 2016.

    Spinal cord injury - chronic management. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T566521/Spinal-cord-injury-chronic-management. Updated December 18, 2015. Accessed October 3, 2016.

    7/20/2015 DynaMed's Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T901291/Medical-uses-of-cannabinoids: Whiting PF, Wolff RF, Deshpande S, et al. Cannabinoids for medical use: a systematic review and meta-analysis. JAMA. 2015;313(24):2456-2473.

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