Spasticity refers to an abnormal, involuntary tightness of muscles which increases when the muscle are rapidly stretched, so that the associated joint appears to resist being moved.
Sometimes this increase in muscle tone may be very slight, or it can be so high that movements are restricted. This may lead to permanent shortening of muscles, called contractures. Occasionally spasticity may be accompanied by clonus, which is a rapid, repetitive contraction and relaxation of muscles. This tends to be more common in the lower limbs, especially at the ankle, rather than in the upper limbs.
What is the cause of spasticity?
Spasticity is usually caused by damage to the portion of the brain or spinal cord that controls voluntary movement. The damage causes a change in the balance of signals between the nervous system and the muscle. This imbalance leads to increased activity or excitability in the muscle.
Which muscles are affected?
Spasticity can affect either individual muscles or a range of muscle groups. Frequently the shoulder areas, as well as the area around the elbow, the lower arm, wrist and hand are affected. In the lower part of the body, it can affect the hips, thighs, knees or feet. The stiffness and spasms resulting from spasticity more commonly affect muscles that work against the force of gravity. In other words, in the arm area, it tends to affect the flexor muscles e.g. biceps, and in the leg, the extensor muscles e.g. quadriceps, muscles in front of the thigh.
When the effects of spasticity are widespread, i.e. affecting most muscles of the arms and legs, it is said to be generalised. If it occurs in most muscles of just one, or perhaps two limbs, it is said to be regional. However, when it is most pronounced in a single muscle group it is said to be focal. This differentiation is important as it will help your doctor to determine which treatment option is best for you.
What are the effects of spasticity?
Some of the features of spasticity include:
- Muscle stiffness
- Difficulty straightening joints
- Reduced mobility
- Limb weakness
- Shaking (clonus)
- Intermitted spasms
As a result of the increased muscle tone due to spasticity ‘simple’ movements become difficult or impossible altogether. This restriction in movement can lead to difficulties with walking, dressing, and carrying out personal hygiene. In addition, painful muscle spasms can lead to difficulty with sleeping, sitting in a chair or lying on a bed. Occasionally spasms may be triggered by fairly minor irritations such as tight clothing, a full bladder or bowel, urinary tract infection or skin irritation, such as from a pressure sore.
How is spasticity managed?
Spasticity occurs as a result of number of long term conditions and unfortunately there is no cure for this problem. It can however be controlled with appropriate treatment. The choice of treatment will be determined by a number of health specialists. This may include neurologists, rehabilitation specialists, physiotherapists, occupational therapists, orthotist, nurse, general practitioner and other carers. There are a number of options available for the treatment of spasticity, some of which may occasionally require the involvement of several health specialists working together as a multidisciplinary team.
During the initial consultation with your healthcare specialist, treatment goals and expectations will be discussed with you. It is important to have clearly defined goals identified and documented before treatment begins as these can be referred to during the course of therapy to ensure that the treatment is working. Occasionally, the treatment option chosen at the start of the therapy may have to be adjusted in order to help you achieve the identified goals. Therapy goals may be as simple as, being able to put on, or wear a splint comfortably. However, they may sometimes be more complex, such as being able to walk more efficiently. The most appropriate therapy goals will be decided upon after a more detailed assessment has been carried out by your healthcare specialist and an in-depth discussion has taken place with you. Once you have achieve the initially identified treatment goals you will then have the opportunity to discuss with your healthcare specialist about identifying more ambitious goals that you can begin working towards achieving.
Therapy goals could be:
- Improving sitting position
- Improving walking pattern
- Improving daily activities e.g. dressing, hygiene
- Reducing the burdens of carers e.g. dressing, feeding, transfer and bathing
- Reducing pain
- Reducing the frequency of spasms
- Avoiding contractures e.g. shortening of muscle
Treating spasticity is difficult and frequently requires a combination of different procedures. The challenge is to establish a treatment plan that can maintain a balance between improved function, patient satisfaction and possible side effects.
Normally, various methods of treatment are combined to get the most effective management of symptoms.