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Spasticity Management and Neuro Rehabilitation

Spasticity Management and Neuro Rehabilitation

  • September 2, 2024
Prevalence:

Nearly 50% of stroke, over 50 % of multiple sclerosis, spinal cord injury
patients develop spasticity.

What is spasticity?

Spasticity is a condition in which there is an abnormal increase in muscle tone or
stiffness of muscle, which might interfere with posture, movement, daily routines or
be associated with discomfort and pain.

In which condition does spasticity develop?

Spasticity is usually caused by the damage to the central nervous system, within the brain or spinal cord. It is frequent amongst stroke survivors and usually manifests itself a few weeks to a few months after the stroke. Spasticity is also very common with spinal cord and brain injury, multiple sclerosis, MND and other neurological conditions.

Signs and symptoms of Spasticity.

  • Stiff, rigid muscles- causing movements to be less precise and making certain
    tasks difficult to perform
  • Involuntary contractions or muscle spasms, and overactive reflexes
  • Clonus (series of fast involuntary muscle contractions that may feel like a
    tremor, most often experienced in ankles)
  • Involuntary crossing of legs
  • Pain at rest and/or during movement
  • Abnormal posture.

Effect of spasticity:

  • Bent elbow and arm pressed against the chest
  • Tight fist, difficult to open hand and maintain hygiene
  • Pointed foot, difficulty to keep foot flat.
  • Curled toes at rest or in walking
  • Stiffness in arms, fingers, knee or legs.
  • Spasm/increased tone may restrict balance, coordination and muscle movement.
  • Decrease in functional ability.
  • Difficulty in care and hygiene, decrease in overall quality of life.
  • Complications like infections, pressure sore.

What are the trigger factors that can make spasticity and spasms worse?

  • Bladder or bowel problems
  • Pain
  • Neurological condition getting worse
  • Other health conditions – such as an infection, pressure sores or an ingrown toenail
  • External triggers – such as tight fitting clothes or being too hot or too cold

Is contracture same as spasticity?

Contracture is when muscles can become so tight that your joints have only limited movement or become fixed in one position. It usually happens in hands, elbows, hips/knees or ankles. If muscle spasticity is not treated, the risk of contracture is higher.

Can we treat spasticity?.

There is effective treatment for this condition; therefore once symptoms are noticed it is important to get patients referred to the right team, as required (therapy team dealing with neurological conditions or neurology team or spasticity specialist service). If untreated, spasticity can cause painful and debilitating bone and joint deformities. Along with medical and/or surgical management of spasticity, Physiotherapy and rehabilitation is vital in managing spasticity, improve quality of movement and function.

Do we need to treat spasticity or Can Spasticity help?

Usually spasticity needs treatment at right time. Some spasticity may also be useful in certain muscle groups as an alternative to muscle voluntary activation to provide support in transfers or standing- Physiotherapist and other professionals specialising in neurological rehabilitation will help in decision making about treatment of spasticity.

How can I help myself in managing spasticity ?

  • Continue the medications as prescribed and report any change in condition
    (to GP and/or neurologist, spasticity service).
  • Monitor for any signs and symptoms of spasticity
  • Monitor for any trigger factors (like signs of urine infection)
  • Continue exercise, stretches and positioning as recommended by specialist
    neurological Physiotherapist. Seek guidance if there is any change in your
    medical condition.
  • Use appropriate splints and assistive devices
  • Maintain your activity level.
  • Keep yourself hydrated.

How can my family and carers help?

  • Be aware of the spasticity, signs and symptoms, trigger factors etc.
  • Monitor and report to therapist and/or neurologist if there is change in quality
    of movement or transfer/walking ability.
  • Monitor for any trigger factors (like signs of urine infection) and seek medical
    attention.
  • Continue exercise, stretches and positioning as recommended by specialist
    neurological Physiotherapist. Seek guidance if there is any change in your
    medical condition.
  • Provide support in using appropriate splints and assistive devices
  • Support in maintaining activity level.

The Spasticity Checklist