Stroke & Spasticity
UNDERSTANDING SPASTICITY
Spasticity is a consequence of any upper motor neuron injury. Common conditions that result in spasticity include: stroke, brain injury, and spinal cord injury.
Muscle stiffness, tightness, rigidity, and inflexibility are often referred to as spasticity. After such an injury, the arms, the legs or even the face can become weak or paralyzed. When this is from a stroke, it typically affects one side of the body. Brain injury is usually worse on one side, but can affect both sides to some degree. Spinal cord injury will typically involve both sides below the level of the injury. When these injuries occur, a patient cannot control muscle movement well. Often weak muscles become “stuck” in a rigid or tight position and cannot comfortably relax when you want them to.
Sometimes, with milder spasticity, you might be able to move your muscles, but they may resist your movements instead of moving smoothly. Moving requires significant effort. Some people with spasticity notice that the arm or leg may fall into an unusual or twisted position while at rest and it might be difficult to straighten this out. Stretching the limb and using braces to restore a more normal limb posture are usually an important part of therapy to control this spasticity. Medications may help as well.
What Causes Spasticity?
After a stroke, the nervous system attempts to “rewire” and repair itself to compensate for the lost motor control. In many cases, the nervous system is unable to restore normal control to all the muscles. Some muscles do not respond at all, while others are significantly overactive, resulting in dysfunctional postures of the shoulder, arm and hand and often leg and foot as well. These dysfunctional muscles at times hide muscles that may actually have good control.
The blocked messages between the brain and the muscles cause arm and leg muscles to cramp or spasm (spasticity) and not respond to your attempts to move as they should. Spasticity limits your coordination and muscle movement, making daily activities such as taking a shower, eating and dressing more difficult.
Spasticity can cause long periods of strong contractions in major muscle groups, which can even be quite painful. These spasms can produce:
A tight fist
Bent elbow
Arm pressed against the chest
Stiff knee
Inverted ankle and curled toes
If left untreated, spasticity can lead to shortened tendons and limbs that can no longer be straightened out. This can also lead to skin breakdown and pressure sores and will dramatically impair your potential to recover useful function in that limb. Contracture causes the muscles in the hand and wrist to tighten and shrink, which can lead to deformity of the joints and progressive loss of function over time. Spasticity is a disorder of [upper motor neurons] and is one of the common complications of a stroke or brain injury. It is also common following a spinal cord injury, multiple sclerosis, cerebral palsy and any other disorder that affects the central nervous system. Often, spasticity develops months or even a year after the injury — and often may become more noticeable during recovery.
Spasticity is a challenging problem, but there are solutions and ways to effectively control it or eliminate it entirely.
Diagnosis & Treatment
A year of rehabilitation is usually the first course of treatment before surgery or other treatments are considered. Treatment techniques our team uses to restore function include:
2. Partial cutting of an overactive nerve (neurotomy)
3. Transfer of nerves to exchange spastic function for good control in important muscle groups (nerve transfer)
4. Lengthening or cutting of tendons that are shortened and immobile
5. Rerouting of tendons to balance forces across a joint (tendon transfer)
6. Spinal cord stimulation is finding its place as an emerging treatment to reduce spasticity and improve function in patients with UMN injuries.
Creating Your Personal Treatment Plan
Our Paralysis Specialists work with you to develop the most effective plan for reducing spasticity and restoring function. In order to determine the best course of treatment for each individual case, we identify the activity present in each muscle and level of control in that particular muscle and how it responds to attempts to move it, attempts to move its antagonist, and attempts to passively move the joint. This information will help guide us in devising the best reconstructive strategy for removing the impediments to well controlled movement This information is usually gathered from a detailed physical examination and EMG studies.
In order to predict the effectiveness of surgical treatment, local injections of Botox may be given prior to surgery. These injections are intended to mimic the effect of surgery by temporarily relaxing the problematic muscle(s).
What You Can Do To Help
Regularly stretching your tight muscles and exercising to develop better control of that limb can help control spasticity. Physical therapy and scheduled home exercise routines can be very helpful in reducing spasticity, but they are not always easy to do, especially at the beginning when you are trying to work your rigid muscles.
Download the Stroke & Hemiplegia
Patient Guide
Schedule a Consult with the Paralysis Center today (844) 930-1001.
Tips to help you get the most from a visit to the Paralysis Center
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your Specialist tells you.
At the visit, write down the name of your diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your specialist gives you.
Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your Paralysis Specialist if you have questions.