Spasticity

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Information for Patients

If you or someone you are close to has spasticity, or if you think you may have

spasticity but don't know for sure, please read this section. You will find

answers to common questions about spasticity, and find links to valuable

information about effective treatment options. Please remember to contact your

medical professional if you have any questions about your own medical situation

and its treatment.

What is spasticity?

Spasticity is a neurological condition causing an abnormal increase in muscle

tone that occurs when that muscle is stretched. Spastic muscles are resistant to

the normal stretching that occurs during use, and may remain abnormally

contracted for long periods.

Who gets spasticity?

Spasticity can occur in neurological disorders that damage parts of the motor

pathways, those regions of the nervous system that control voluntary movements.

The most common disorders leading to spasticity are cerebral palsy, spinal cord

injury, multiple sclerosis, stroke, and traumatic brain injuries, such as from

lack of oxygen, physical trauma, hemorrhage, or infection.

What causes spasticity?

Spasticity occurs when muscles receive improper nerve signals causing them to

contract (become shorter, or flexed) when they should relax (remain unflexed).

Improper control of signals is due to damage within the brain or spinal cord.

To understand more, you may wish to read about how muscles are normally

controlled.

Normal Muscle Control

(Note: The information on normal muscle control is somewhat detailed. You can

read other sections without it if you prefer.)

What triggers spasticity?

Spasticity may not be present all the time. It can be brought on by rapid

movement, or by sensory stimulation. An important aspect of spasticity treatment

is minimizing the types of stimuli that can trigger it: pain, pressure sores,

urinary tract infection, ingrown toenails, restrictive clothing, and

constipation, for example.

What are the symptoms of spasticity?

The symptoms of spasticity can range from slight muscle stiffness to deformity

and permanent muscle shortening, called contracture . Clonus, or rapid,

repetitive muscle spasm, is also possible. Spasticity can be painful, especially

if it pulls joints into abnormal positions or prevents normal range of motion.

While spasticity can affect any muscle group, there are some common clinical

patterns. To see photos illustrating these, click here.

What are the complications of spasticity?

Activities of daily living : The inability to control muscles independently can

mean increased difficulty in activities of daily living such as dressing,

eating, and grooming.

Hygiene: Stiff, contractured muscle can prevent access to such areas as the

palm, armpit, or groin, interfering with hygiene. Odor and skin breakdown may

occur. Bowel and bladder care may be more difficult.

Mobility: Spasticity in the leg muscles can interfere with mobility, seating,

and transfers, such as from bed to wheelchair or from sitting to standing.

Comfort: Spasticity may make it difficult to sit comfortably, or to change

positions frequently enough to prevent joint pain and pressure sores. Spasticity

in the feet can prevent comfortable fitting of shoes. Severe spasticity may

cause painful joint misalignments.

What is contracture?

A contracture is an abnormal joint posture due to persistent muscle shortening.

Contracture is one of the most significant consequences of spasticity. When a

muscle is not regularly put through its full range of motion, its tendons

shorten. This makes stretching the muscle even more difficult, setting up a

vicious cycle of even more shortening and decreased stretch. The muscle may

develop fibrous scar tissue, further preventing full range of motion. The end

result of untreated contracture is a permanent, often painful, abnormal posture.

Can spasticity be treated?

Yes, although it is important to note that in some cases, no treatment is

necessary or desirable. Evaluation by a medical professional is crucial to

determine the best course of treatment.

There are several types of treatment available for spasticity. The most

important one is regular stretching exercises prescribed by a physical

therapist. Early on in contracture development, regular stretching ( " range of

motion exercises " ) can help prevent permanent shortening. For some people with

spasticity, this is the only treatment necessary. Muscle relaxing drugs, taken

orally or pumped into the spinal fluid, are available for spasticity affecting

several regions of the body. Local injections of drugs that weaken or paralyze

overactive muscle (chemodenervation agents ) can be effective for more isolated

spasticity. Severe spasticity that cannot be effectively treated with drugs or

injections may respond to surgical destruction of some overactive nerves in the

spine. Contracture may be treated with serial casting to allow tendons to

stretch, or orthopedic surgery if required.