6 things you should know about spasticity!
Spasticity is abnormal muscle tightness and is associated with a damage in the brain, on the spinal cord or motor nerves. It appears in diagnosis such as cerebral palsy (CP), stroke, Multiple sclerosis (MS), acquired brain injury or spinal cord injury.
- What is spasticity?
- What causes spasticity?
- What does spasticity look like?
- How does spasticity change over time?
- How does spasticity affect everyday life?
- How is spasticity managed?
1. What is spasticity?
Spasticity is an abnormal increase in muscle tone or stiffness of muscles. It often interferes with movement of the body and limbs and will in many cases also affect speech. Spasticity often increases when limbs are moved quickly. Muscle contractions may occur spontaneously or as a result of sensory stimuli.
2. What causes spasticity?
Voluntary movement of the body involves a well coordinate communication between the brain and nerves to the muscles. When a specific area in the brain called “the motor cortex” is damaged, or there is a spinal cord injury, spasticity may occur and disrupt the flow of signals to and from the muscles. This affects a person’s ability to control movements of the body.
3. What does spasticity look like?
Spasticity looks differently according to diagnosis and severity, but there are some common patterns.
If the upper limbs are affected we often see the elbow, wrist and fingers are bent. This influences the person’s ability to use the hands for eating, drinking, dressing, writing, manipulating objects and handling personal hygiene. We also use our arms when balancing, and therefor spasticity in upper limbs may also affect standing and walking.
Spasticity in lower limbs will cause bending of the hips and knees, crossing of legs and toes pointing downwards. These postures will cause difficulties for positioning in both lying, sitting, standing and walking.
Many people who suffer from spasticity also experience that it has impact on speech. This because the facial muscles and tongue are affected. It often causes slow oral movements, and it takes a lot of effort to form words. Swallowing of food and drinks may also be challenging.
To what degree spasticity influences positioning, movement and everyday life is depending on the severity. If only one arm and hand is spastic the child or adult may live close to a normal life by compensating for the disability using the other arm more frequently. While people who are more severely affected by spasticity are relying on assistive devices and assistance to compensate for the disability. They are also at high risk for developing secondary complications, which will be covered in the next chapter.
4. How does spasticity change over time?
The injury causing spasticity does not change over time in diagnosis like CP, SCI and stroke, but the spasticity can change.
In children with CP studies have shown that muscle tone increases until the age of 5. After 5 years of age the muscle tone seems to decrease up to 15 years of age. The rate of increase and decrease before and after 5 years of age is higher in more severely affected children with CP (GMFCS IV and V).
Read also: What is GMFCS, and why is it used?
Spinal cord injury
In people with spinal cord injury spasticity typically develops gradually over several months after the injury. How it develops and the degree of spasticity is depending on location and extent of the injury.
Around 30% of people suffering from stroke develop spasticity. The development of spasticity happens within the first few days or weeks, and the most affected parts of the body are elbows, wrists and ankles.
Large Multiple sclerosis (MS) registers show us that over 50% of people with MS develop spasticity. Spasticity is seen in all types of MS and all levels of severity from mild to severe spasticity are observed.
So, as you can see, change of spasticity and how the condition develops is different from diagnosis to diagnosis and will also vary in severity within a diagnosis.
5. How does spasticity affect everyday life?
If you or your child have spasticity, the most important aspects to consider and discuss with your doctor, physiotherapist and other professionals around you, are: How does spasticity affect everyday life?
- Personal hygiene
- Moving from A to B
- Pressure sores
What does spasticity mean to you?
To what extend is it disturbing you in everyday life and in which situations can spasticity on the contrary be positive for you? Spasticity is not just negative. Beneficial effects are often seen in the ability to mobilise power to stand and walk.
What do you want to be able to do?
Reflect on what is important to you or your child to be able to do in everyday life.
Considering and discussing all these questions with the professionals around you will improve the process of finding the right treatment for you or your child.
6. How is spasticity managed?
Spasticity management programs need to be individualised and relevant in accordance with severity, age and developmental potential. Spasticity should always be continually monitored to record development, secondary consequences and response to treatment. A multidisciplinary team will be involved in recommending the right treatment. Here you have a description of the most typically treatments for spasticity.
The aim of physiotherapy in relation to spasticity is to:
- Maximise motor function and ability to participate in everyday activities.
- Prevent secondary complications.
The therapist will set specific goals together with the individual person and plan for dosage of training. Assistive technology and orthoses are tools used in conjunction with therapy to enable independency and prevent secondary complications such as contractures, deformities and pain.
Read also: Why 24-hours posture care management is key
Medication and surgery
Botulinum toxin is a medication injected directly into the spastic muscle to reduce over-activity. It takes 7-10 days before the medication has effect, and it lasts from 3-6 months. This medication is mainly used when it is only a few muscles involved. Botulinum toxin can be used to improve function, accommodate care and hygiene and reduce pain.
Diazepam is given as a tablet and relaxes muscles. Is does also have an effect on pain. This medication is only given short-term. For more long-term treatment Baclofen should be considered.
Baclofen is a medication that acts directly on nerve cells and decreases the excitability of the nerves and therefore reduces spasticity. It can be used orally or intrathecally. Oral form of baclofen has limited efficacy in low doses, and you will need long time to increase the dose. Typically, 3-4 weeks before you will see an effect. Intrathecal baclofen is delivered directly into the spinal level and is more effective at lower dose. Placement of the baclofen pump requires a surgical procedure. The benefit of intrathecal baclofen is great reduction of severe spasticity, especially in the lower limbs. Although this can also for some people mean they lose strength in their legs which may affect transfer and mobility.
Selective Dorsal Rhizotomy surgery (SDR) involves cutting of some of the sensory nerve fibres that come from the muscles and enter the spinal cord. SDR is the only procedure that can provide permanent reduction of spasticity.
- Lindén O, Hägglund G, Rodby-Bousquet E, Wagner P. The development of spasticity with age in 4,162 children with cerebral palsy: a register-based prospective cohort study. Acta Orthopaedica. 2019:1-10.
- Elbasiouny SM, Moroz D, Bakr MM, Mushahwar VK. Management of spasticity after spinal cord injury: current techniques and future directions. Neurorehabilitation and neural repair. 2010;24(1):23-33.
- Rekand T, Hagen EM, Grønning M. Spasticity following spinal cord injury. Tidsskrift for Den norske legeforening. 2012
- Thibaut A, Chatelle C, Ziegler E, Bruno M-A, Laureys S, Gosseries O. Spasticity after stroke: Physiology, assessment and treatment. Brain Injury. 2013;27(10):1093-105.
- Mayer NH, Esquenazi A. Muscle overactivity and movement dysfunction in the upper motoneuron syndrome. Physical medicine and rehabilitation clinics of North America. 2003;14(4):855-83, vii-viii.
- Wissel J, Schelosky LD, Scott J, Christe W, Faiss JH, Mueller J. Early development of spasticity following stroke: a prospective, observational trial. J Neurol. 2010;257(7):1067-72.
- Patejdl R, Zettl UK. Spasticity in multiple sclerosis: Contribution of inflammation, autoimmune mediated neuronal damage and therapeutic interventions. Autoimmunity Reviews. 2017;16(9):925-36.
- Nice Guidelines, Spasticity
Rikke Damkjær Moen brings many years of experience as clinical physiotherapist to the Made for Movement team. Her mission is to ensure that everybody, regardless of mobility problems, should be able to experience the joy and health benefits of physical activity. As our Medical Manager, Rikke is passionate about sharing knowledge so that individuals with special needs, families, and clinicians can discover the possibilities and solutions provided by Made for Movement.
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