What is Spasticity?

Spasticity is a condition in which muscles that are certain continuously contracted. This contraction causes tightness or stiffness of the muscles and will restrict speech, normal movement, and gait. Spasticity is usually caused by damage to the percentage of the mind or spinal cord that controls motion that is voluntary. The damage causes an alteration in the balance of signals between your system that is nervous the muscles. This imbalance leads to enhanced activity in the muscles. Spasticity negatively affects muscles and bones of the extremities and is very harmful to grow children.

Prevalence and Incidence

  • Spasticity affects significantly more than an estimated 12 million individuals globally.
  • About 80% of people with cerebral palsy (CP) has varying levels of spasticity. With a predicted 500,000 people in the United States with some CP, this equates to about 400,000 individuals with some extent of CP-related spasticity.
  • About 80 percent of individuals with multiple sclerosis (MS) have varying degrees of spasticity. This means about 320,000 people with some degree of MS-related spasticity having an approximated 400,000 individuals into the United States with MS.
    Other conditions which could cause spasticity include:
  • Traumatic brain injury (TBI)
  • Spinal cord injury (SCI)
  • Brain damage due up to an absence of oxygen
  • Stroke
  • Meningitis
  • Encephalitis
  • Amyotrophic sclerosis that is lateralLou Gehrig’s illness)
  • Phenylketonuria
  • Spasticity in Cerebral Palsy (CP)
  • Adrenoleukodystrophy

In an individual with CP, brain harm has occurred. The damage is often in the area of the brain that controls muscle tissue tone and movement of the arms and legs for unknown reasons. Therefore, the brains of those with CP are unable to influence the actual number of flexibility muscles needs to have. The command from the muscle itself dominates the cord that is spinal results in muscle tissue that are too tight or spastic. People born with CP do not have deformities of the extremities present at birth, but develop them in the long run. Spasticity of muscles, along with the limitations on stretching and make use of muscles in daily tasks, is a cause that is major of deformities.

Spasticity in Multiple Sclerosis (MS)
Spasticity is a very prevalent symptom of MS. There are two types of MS-related spasms: extensor and flexor. Flexor spasticity is an involuntary bending of this hips or knees (primarily relating to the hamstring muscles on the straight back for the top leg). The hips and knees bend up toward the upper body. Extensor spasticity is a straightening that is involuntary of legs. Extensor spasticity includes the quadriceps (muscles on the front side of the leg that is upper and the adductors (inner thigh muscles). The hips and knees remain right with the legs very close together or crossed over at the ankles. Spasticity might also occur in the arms but is less common in people who have MS.

Spasticity may worsen as a result of movements being sudden place modifications, muscle tightness, temperature extremes, humidity or infections. It may even be created by very tight clothes.

Although there is no definitive cause of spasticity, it is thought to be associated with an interruption of descending inhibitory nerve signals along the spinal cord and brain, which causes an imbalance between inhibition and excitation. Descending inhibitory messages from the brain. Upper motor neurons descend from the motor cortex of the brain to the spinal cord. Some of these neurons carry inhibitory messages. Lower motor neurons are the pathway from the spinal cord to the muscle fibers. Excitatory messages from the muscle. Sensory pathways carry information, including excitatory messages, to the brain. Damage to the upper motor neuron pathways such as the reticulospinal, vestibulospinal, and rubrospinal tracts can result in a lack of inhibition, causing spasticity.

Spasticity in Traumatic Mind Injury (TBI)
Spastic hypertonia often does occur after having a TBI as a total outcome of damage to your brain stem, cerebellum or mid-brain. This damage impacts the reflex centers into the brain, interrupting message flow along different nerve paths. This disruption can cause changes in muscle mass tone, motion, reflex, and sensation. The location of the TBI may determine which aspects of the physical human anatomy are affected and exactly what motor deficits happen. The reflex abilities in the brain are more complicated than those in the cord that is spinal. This makes the treatment of spastic hypertonia in individuals with TBI more challenging to take care of compared to persons with spinal cord injuries or neurological disorders.

Soon after brain damage occurs, many people encounter a period of increased muscle tone in which their body position becomes rigid. A typical elbow’s position held rigidly at the sides, wrists and fingers bent, and fists clenched. The legs are extended at the sides and knees with ankles and toes flexed. Being a TBI patient recovers, nerve signals that control motor functions may change. Some signals may perhaps not reach the reflex facilities of the brain, or the mind may deliver signals which can be too many causing the muscles not to react correctly.

Spasticity may be as mild while the sensation of tightness in muscles or may enough be serious to make painful, obstinate spasms of this extremities; most frequently the arms and legs. Spasticity may also produce tremors of pain or tightness in and around joints and can straight back cause low pain.

Adverse effects of spasticity include:

  • Strength stiffness, causing motions to be less exact and making certain tasks difficult to perform
  • Strength spasms, causing uncontrollable and muscle mass that is normally painful
  • Involuntary crossing regarding the legs
  • Muscle fatigue
  • Muscle and deformities that are joint
  • Inhibition of longitudinal muscle tissue growth
  • Inhibition of protein synthesis in muscle cells
  • Additional complications
  • Endocrine system infections
  • Chronic constipation
  • Fever or other illnesses which can be systemic
  • Pressure Sores

Treatment Options

There are several kinds of therapy available that must be evaluated for a foundation that is case-by-case depending on the underlying cause, the age of the in-patient and extent associated with spasticity. Different remedies share the typical goals of:

  • Relieving the signs and symptoms of spasticity
  • Reducing the frequency and pain of muscle contractions
  • Improving gait, hygiene, tasks of day-to-day ease and living of care
  • Reducing caregiver challenges such as dressing, feeding, bathing, and transport
  • Improving motor that is voluntary involving objects such as reaching for, grasping, moving and releasing
  • Enabling more muscle that is normal in young ones
  • Physical and Occupational Therapy
  • Physical and therapy that is occupational spasticity are designed to reduce muscle tone, maintain or improve range of motion and fluidity, increase strength and coordination and enhance comfort.
  • Treatment may include stretching and strengthening exercises, short-term braces or casts, limb positioning, application of cold packs, electric stimulation, and biofeedback.

Oral Medications
The use of oral medicines to deal with spasticity could be indicated when symptoms affect daily functioning or with rest. Effective medication management may need the use of two or more medications or perhaps a combination of dental medications with another kind of therapy. It is essential to work closely with a doctor to devise a treatment plan that is individualized. Side effects can change considerably by class of medication and patient.

Medications include:

  • Baclofen
  • Benzodiazepines
  • Dantrolene sodium
  • Imidazolines
  • Gabapentin
  • Botulinum Toxin (BTA) Injections
    BTA, also known as Botox injections, when used in tiny amounts, have proven effective in paralyzing muscle tissue which are spastic. Injection internet sites are very carefully determined predicated on the pattern of spasticity.

Whenever Botox is inserted into the s that are muscle(, the production of acetylcholine is obstructed, causing a relaxation of overactive muscles. The injection(s) take effect within a few days and last about 12-16 weeks until new nerve endings grow back and the simulated muscle(s) recover. Functional benefits may last longer than this. There are limitations in the true amount of injections that can be administered.

The main neurosurgical procedures to treat spasticity are intrathecal baclofen (ITB) pumps and dorsal that is selective (SDR).

Intrathecal Baclofen (ITB)
In serious cases of spasticity, baclofen can be administered through a pump that has been surgically implanted within the patient’s abdomen. An infinitely more powerful reduction in spasticity and pain can be achieved, with fewer side effects by delivering baclofen straight to the spinal fluid. ITB has been discovered to be extremely effective in treating spasticity in the reduced and extremities that are upper.

Selective Dorsal Rhizotomy (SDR)
In SDR, the neurosurgeon cuts selective neurological roots (rhizotomy), the nerve materials located just beyond your backbone (spinal column) that send sensory messages from the muscles to the cord that is spinal. SDR is used to treat spasticity that is serious of feet that interferes with motion or placement. By cutting only the nerve that is sensory causing the spasticity, muscle stiffness is decreased, while other functions stay intact. Decreasing spasticity can improve mobility and function and help avoid muscle that is serious (contractures), as well as joint and bone deformities. It is utilized most effectively in patients with CP who meet particular requirements. People with the requirements that are following not candidates for SDR:

  • Clients who’ve experienced meningitis, congenital mind infection, congenital hydrocephalus unrelated to premature birth, head trauma or disease that is familial
  • Patients who have mixed CP with predominant rigidity or dystonia, significant athetosis or ataxia
  • Patients with severe scoliosis
  • Clients that will not make gains that are functional surgery

The many benefits of surgery must always carefully be weighed against its risks. Randomized, controlled clinical trials have exhibited that a large percentage of CP patients report a decrease that is significant spasticity and enhanced function after surgery. However, surgery just isn’t a choice for all full instances of spasticity.