Spasticity

What Causes Spasticity?

Spasticity is usually caused by damage to nerve pathways within your brain or spinal cord that control movement and stretch reflexes.

Spasticity may occur due to several conditions, including:

• Spinal cord injury.
• Multiple sclerosis (MS).
• Cerebral palsy.
• Stroke.
• Brain or head injury.
• Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease.
• Hereditary spastic paraplegias.
• Adrenoleukodystrophy (ALD).
• Phenylketonuria.
• Krabbe disease.

What Are The Symptoms Of Spasticity?

Spasticity can involve the following:

• Increased muscle tone (hypertonia).
• Muscle spasms (quick and/or sustained involuntary muscle contractions).
• Clonus (series of fast involuntary muscle contractions that may feel like a tremor, most often experienced in your ankles).
• Involuntary crossing of your legs.
• Pain or discomfort.
• Abnormal posture.
• Contracture (permanent contraction of the muscle and tendon due to severe lasting stiffness and spasms).
• Muscle, joint and/or bone deformities.
• Difficulty performing daily activities, and difficulty for others to help with activities such as dressing and bathing.
• Sleep disruption due to, for example, painful spasms or muscle tightness.

There is a difference between muscle spasticity and rigidity. They are both hypertonic states (a state of abnormally high muscle tone), but they’re different.

Rigidity is often seen with Parkinson’s disease, and involves a part the brain that’s involved with coordination of movement.

Unlike spasticity, rigidity affects all of the muscles surrounding a particular joint equally. The increased muscle tone remains constant throughout the range of movement of the affected joint.

With spasticity, more rapid movements will trigger a stronger involuntary contraction or “catch” of the affected muscles.

There can be complications of spasticity that can vary. If severe, spasticity can interfere with daily function and cause extreme pain. It can also make it more difficult to perform hygiene tasks and basic care. This can increase the risk of developing pressure injuries (bedsores), which can lead to infection and sepsis.

If left untreated, moderate to severe spasticity can also lead to:

• Contractures (frozen or immobilized joints).
• Bone fractures.
• Partial or full dislocation of joints.
• Urinary tract infections (UTIs).
• Chronic constipation.

What Are My Treatment Options For Spasticity?

People who have spasticity usually undergo more than one treatment at a time. Though there’s no cure for spasticity, these treatments can help alleviate symptoms and improve quality of life.

Having a team of healthcare professionals in different specialties is the most effective way to treat. Team members may include:

• Neurologist.
• Physiatrist (a rehabilitation specialist).
• Advanced practice clinician.
• Physical therapist.
• Occupational therapist.
• Speech and language pathologist.
• Neurosurgeon.
• Orthopaedic surgeon.
• Pain specialist

Nonsurgical treatments for spasticity include:

• Physical therapy: A physical therapist generally focuses on lower extremity stretching and strengthening exercises and mobility training (transfers, standing and walking).
• Occupational therapy: An occupational therapist generally focuses more on upper extremity stretching, strengthening and training to perform daily activities, such as grooming, bathing and cooking.
• Speech therapy: If you have spasticity that affects your mouth, face and throat muscles, a speech therapist can help with your speech, communication and swallowing.
• Casting or bracing: Using casts or braces for affected regions of your body can help provide a sustained stretch of spastic muscles to improve range of motion and can facilitate function.
• Assistive devices: A wide variety of assistive devices can help a person with spasticity move around and perform daily tasks more efficiently and more safely.

You may be prescribed oral medications in combination with other therapies. Medications usually will be prescribed if your spasticity disrupts daily functioning or sleep. Common medications for spasticity include:

• Baclofen (Lioresal®).
• Tizanidine (Zanaflex®).
• Dantrolene sodium (Dantrium®).
• Diazepam (Valium®).
• Clonazepam (Klonopin®).
• Gabapentin (Neurontin®).

These medications for spasticity are often effective but may cause side effects such as drowsiness and weakness.

Botox (botulinum toxin) injections into spastic muscles can be very effective for treating spasticity. These shots can reduce symptoms in selected muscles causing the most tightness or spasm.

During these injections, your provider injects the Botox into carefully selected sites in your muscle, causing spastic muscles to relax. This may improve comfort, positioning and function. The effects usually take seven to 10 days to become noticeable and typically last around three months.

Botox therapy is usually recommended when spasticity relief only involves a few muscle groups. It can be used in addition to other treatments for spasticity.

Healthcare providers typically only recommend surgical treatments for spasticity in severe cases. These types of treatment include:

• Intrathecal baclofen (ITB) therapy: This treatment involves surgically placing a pump in your abdomen that can release a steady dose of the medication baclofen directly to your spinal fluid through a catheter connected to the pump. This can lead to a significant reduction in spasticity and pain with a lower risk of drowsiness compared to taking baclofen orally.
• Selective dorsal rhizotomy (SDR): Spasticity can be caused by an imbalance in electrical signals to certain muscles. SDR rebalances the electrical signals sent to your spinal cord by surgically cutting carefully selected nerve roots. Surgeons only perform this procedure for severe spasticity affecting your legs. Precise cutting of problematic nerve roots can decrease muscle stiffness while maintaining other functions. Providers most commonly recommend SDR for people with cerebral palsy.
• Orthopedic surgery: This involves surgery that deals with treating the consequences of spasticity on muscles, bones and connective tissue, such as contractures and deformities. Examples include tendon lengthening and tendon transfer procedures.