Spasticity

Spasticity is a medical condition in which some muscles tighten and contract more than usual. It can result in muscles that are stiff and do not work effectively. This can result in reduced function and affect walking, use of the arms and hands, and even speech. The most common cause of spasticity is some form of damage to the spinal cord or brain that can result from an injury or illness. While spasticity often cannot be cured, there are treatments that can help reduce its effects on function and prevent additional damage to bones and other parts of the body.

Background

Muscle movement is caused by signals carried from the brain by nerves. These nerves travel from the brain down the spinal cord before branching off to various parts of the body. The connection between the brain, spinal cord, and nerves forms an intricate communication system that functions quickly and efficiently when it is healthy and intact. When any part of this system is damaged, however, it interrupts the efficiency, speed, and accuracy of the communication between the brain and the muscles. The muscles do not get the correct messages from the brain, causing the muscles to react to minor stimuli as if they are much more significant.

For instance, the simple touch of clothing on a hand might cause it to contract as if the body is trying to protect itself from something hot. The muscles also tend to hold that tightened position, causing the limb to twist into positions that are neither normal nor comfortable. These contractions can be caused by any pressure, injuries that cause minor pain such as a cut or ingrown nail, or even by simply moving or stretching the limb.

Traumatic injuries to the brain or spinal cord and several health conditions are the most common causes of spasticity. People who suffer injuries to the head or neck in motor vehicle accidents, diving or skiing accidents, falls from heights, or from military combat are among those who might incur traumatic brain injuries. These injuries limit how the messages travel back and forth to the brain and can affect everything from voluntary movements like reaching to pick something up to reflex reactions such as pulling back from something hot. Brain injuries can also be caused by lack of oxygen, as might result from a near drowning or choking incident, for example.

Some of these injuries occur either before or during birth and result in a condition known as cerebral palsy (CP). These injuries often affect the part of the brain that controls the voluntary muscles of the limbs and prevents the person from being able to make his or her arms or legs move as he or she would like. Another illness that can cause spasticity is multiple sclerosis (MS). In some cases, the spasticity causes muscles of the knees or hips to tighten in a flexed or bent position. This is known as flexor spasticity. In other cases, MS causes muscles to tighten in an extended position, resulting in extensor spasticity. Patients with this condition experience leg muscles that resist bending at the knees and hips.

A number of other illnesses can cause spasticity. These include brain infections such as meningitis and encephalitis; diseases that affect the nerves such as amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease); or a birth defect called phenylketonuria (PKU), which causes high levels of an amino acid called phenylalanine to build up in the body. Strokes, or a sudden loss of blood flow to the brain, are another common cause of brain damage that can cause spasticity.

Overview

People affected by spasticity can have symptoms of varying intensity. Sometimes, it might feel like a mild tightness or cramping. In other cases, it can cause extreme spasms that are unrelenting and painful. Many patients experience spasticity of different intensities in different parts of their bodies. In addition to the muscle pain during the contracture, the patient may also experience achiness of the surrounding area both during and after the spasm.

Spasms often affect the patient’s ability to move. This commonly happens in the limbs and can prevent a person from standing, walking, sitting upright, using the arms, and performing tasks such as dressing or eating that require fine motor skills of the hands and fingers. The patient may also experience involuntary movements, such as flailing arms and legs that cross on their own. The unusual stress on the muscles can cause deformities to the muscles as well as the joints and bones to which they attach. The condition can also cause the muscles to fail to grow as they should. This is especially a problem for children affected by spasticity.

While spasticity is most commonly thought of as affecting the limbs, any muscle in the body can be affected. Some patients experience difficulty speaking or may have problems with their vision. When muscles in the bladder and bowels are affected, the patient may experience urinary tract infections or issues with constipation.

There are several goals in treating a patient with spasticity. The most immediate concern is often relieving the pain caused by extreme muscle contractions. Restoring function that has been affected by the spasms is also a primary concern. Enabling the patient to care for himself or herself or reducing how much assistance is needed from caregivers will also be given priority. When the patient is a child, effort will also be directed toward helping the child’s muscles and bones to grow as normally as possible.

Patients will usually have physical and occupational therapy to help with spasticity. Physical therapy helps to strengthen and stretch muscles to reduce spasms and increase function. Occupational therapy helps patients learn to use what muscle function they do have to accomplish everyday tasks such as dressing and eating.

Oral medications are often used to reduce the spasms and the related pain and complications. This includes muscle relaxants such as baclofen, benzodiazepine, and dantrolene sodium. Some patients are treated with injections of botulinum toxin, which effectively causes localized paralysis of the muscles, or other medications that temporarily block the ability of the muscle to tighten. In severe cases, patients may have a tube inserted that allows medication to be pumped directly into the spinal cord to help control symptoms. Another option for treating spasticity is surgery to sever the affected nerves.

Bibliography

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Pandy, Krupa. “Spasticity Medication.” Medscape, 1 Mar. 2018, emedicine.medscape.com/article/2207448-medication. Accessed 27 Nov. 2018.

Pandy, Krupa. “Spasticity Treatment and Management.” Medscape, 1 Mar. 2018, emedicine.medscape.com/article/2207448-treatment. Accessed 27 Nov. 2018.

Petropoulou, Konstantina. “Managing Spasticity with a Focus on Rehabilitation.” International Neuromodulation Society,9 Feb. 2018, www.neuromodulation.com/managing-spasticity-with-a-focus-on-rehabilitation. Accessed 27 Nov. 2018.

“Spasticity.” American Association of Neurological Surgeons, www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Spasticity. Accessed 27 Nov. 2018.

“Spasticity.” Cleveland Clinic, my.clevelandclinic.org/health/diseases/14346-spasticity. Accessed 27 Nov. 2018.

“Spasticity.” WebMD, www.webmd.com/pain-management/pain-management-spasticity#1. Accessed 27 Nov. 2018.

“Spasticity and Spinal Cord Injury.” Northwest Regional Spinal Cord Injury System, 2011, sci.washington.edu/info/pamphlets/spasticity‗msktc.pdf. Accessed 27 Nov. 2018.