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Spasticity is a disruption in muscle movement patterns that causes certain muscles to contract all at once, leading to abnormal muscle tightness. It is caused by damage to the nerve pathways that control muscle movement, specifically the central nervous system (CNS) encompassing the brain and spinal cord. This damage results in an imbalance of signals between the nervous system and muscles, leading to increased nerve excitability and muscle contractions. Spasticity can affect muscles anywhere in the body but is most commonly found in the leg muscles. The severity of spasticity varies greatly and can range from mild tightness to severe, uncontrollable stiffness and spasms. Treatment options include physical therapy, medication, and in severe cases, surgery.
| Characteristics | Values |
|---|---|
| Definition | A disruption in muscle movement patterns that causes certain muscles to contract all at once when trying to move or even at rest. |
| Cause | Damage to nerves in the central nervous system (brain and spinal cord) that control voluntary movements. |
| Symptoms | Muscle stiffness, spasms, and involuntary contractions that can be painful. |
| Treatment | Physical therapy, medication, surgery, speech therapy, casting or bracing, and Botox injections. |
| Occurrence | Spasticity affects over 12 million people worldwide, including a high percentage of people with cerebral palsy and multiple sclerosis. |
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What You'll Learn
Spasticity is caused by damage to the central nervous system
Spasticity is a disruption in muscle movement patterns that causes certain muscles to contract all at once when a person tries to move or even when they are at rest. This can affect movement and speech. Spasticity is usually caused by damage to nerve pathways within the brain or spinal cord that control movement and stretch reflexes. This damage causes a change in the balance of signals between the nervous system and the muscles, leading to increased excitability in the muscles. The condition is typically a result of an insult to the central nervous system or motor neurons.
Spasticity is found in conditions where the brain or spinal cord are damaged or fail to develop normally. These include cerebral palsy, multiple sclerosis, spinal cord injury, and acquired brain injury, including stroke. Damage to the central nervous system (CNS) as a result of a stroke or spinal cord injury alters the net inhibition of peripheral nerves in the affected region. This change in input to bodily structures tends to favour excitation and, therefore, increases nerve excitability. CNS damage also causes nerve cell membranes to rest in a more depolarized state. The combination of decreased inhibition and an increased depolarized state of cell membranes decreases the action potential threshold for nerve signal conduction and thus increases the activity of structures innervated by the affected nerves (spasticity).
Spasticity is often accompanied by paresis and other signs, such as increased stretch reflexes, collectively called upper motor neuron syndrome. Paresis particularly affects distal muscles, with a loss of the ability to perform fractionated movements of the digits. Upper motor neuron syndrome results from damage to descending motor pathways at the cortical, brainstem, or spinal cord levels. When the injury that leads to spasticity is acute, muscle tone is flaccid with hyporeflexia before the appearance of spasticity. The interval between injury and the appearance of spasticity varies from days to months according to the level of the lesion.
Spasticity can be differentiated from rigidity with the help of a simple clinical examination, as rigidity is a uniform increase in the tone of agonist and antagonist muscles that remains the same throughout the range of movement. In contrast, spasticity is a velocity-dependent increase in tone resulting from the hyperexcitability of stretch reflexes. It primarily involves the antigravity muscles – flexors of the upper limb and extensors of the lower limb. During the passive stretch, a brief "free interval" is appreciated in spasticity but not in rigidity because the resting muscle is electromyographically silent in spasticity.
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Spasticity affects muscle movement
Spasticity is a disruption in muscle movement patterns that causes certain muscles to contract all at once when a person tries to move or even when at rest. It can affect movement and speech. Spasticity can vary greatly in how it affects different people. It may be as mild as the feeling of tightness in the muscles, or it may be so severe that it causes painful, uncontrollable stiffness and spasms in the extremities.
Spasticity is caused by damage to the nerve pathways that control muscle movement. This damage can be a symptom of several conditions and diseases, including cerebral palsy, multiple sclerosis, spinal cord injury, and acquired brain injury, including stroke. The damage causes a change in the balance of signals between the nervous system and the muscles, leading to increased activity (excitability) in the muscles. Receptors in the muscles receive messages from the nervous system, sensing the amount of stretch in the muscle and sending that signal to the brain. The brain responds by sending a message to reverse the stretch by contracting or shortening the muscle.
Spasticity can affect muscles in any part of the body but is most common in the leg muscles. Arm and leg muscles may be affected. It can cause continuous muscle stiffness, spasms, and involuntary contractions, which can be painful. A person with spasticity may find it difficult to walk or perform certain tasks. In children, spasticity can result in growth problems, painful and deformed joints, and disability.
There are several treatment options for spasticity, and patients usually undergo more than one treatment at a time. Treatments include physical therapy, stretching and strengthening exercises, medication, surgery, and speech therapy for patients whose spasticity has affected their speech.
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Spasticity can be treated with medication
Spasticity is a disruption in muscle movement patterns that causes certain muscles to contract all at once. It can affect movement and speech and cause muscle stiffness, spasms, and involuntary contractions, which can be painful. Spasticity is often treated with medication, physical therapy, or surgery.
Oral medications are often used to treat spasticity, but they can cause side effects such as drowsiness, dizziness, and weakness. The most common oral medications are baclofen, lioresal, tizanidine, gabapentin, and dantrolene. Baclofen is an agonist at GABA receptors, which are inhibitory. It restricts the influx of calcium into neural receptors and increases the influx of potassium, causing a decrease in muscle contractions. Intrathecal baclofen (ITB) therapy involves surgically placing a pump in the abdomen that releases a steady dose of baclofen directly into the spinal fluid through a catheter. This method has been found to reduce spasticity and pain with a lower risk of drowsiness compared to oral baclofen.
Injections of botulinum toxin (Botox) or phenol into spastic muscles can also be used to treat spasticity. These injections selectively reduce tone in muscles causing tightness or spasms, improving comfort, positioning, and function. Botulinum toxin injections are typically considered when spasticity needs to be relieved in only a few muscle groups and can be used in addition to other treatments. Phenol injections prevent the transmission of too many nerve impulses without causing a debilitating lack of control or sensation.
In severe cases of spasticity, surgery may be recommended to treat the condition and improve mobility. Selective dorsal rhizotomy (SDR) is a procedure that rebalances the electrical signals sent to the spinal cord by cutting carefully selected nerve roots. Orthopaedic surgery deals with treating the consequences of spasticity on muscles, bones, and connective tissue.
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Spasticity can be treated with physical therapy
Spasticity is a disruption in muscle movement patterns that causes certain muscles to contract all at once when you try to move or even at rest. It can affect movement and speech. It is caused by damage to the central nervous system (CNS), specifically the brain or spinal cord, which disrupts the normal communication between muscles and the brain. This results in abnormal muscle tightness and stiffness, spasms, and involuntary contractions that can be painful and disabling.
While there is currently no cure for spasticity, various treatment options can help manage symptoms and improve quality of life. One of the key treatments is physical therapy, which can be highly effective in reducing spasticity and its impact on an individual's functioning. Physical therapy typically involves a range of exercises and techniques designed to improve muscle flexibility, range of motion, coordination, and strength. Lower extremity stretching and strengthening exercises are often recommended, along with mobility training for activities such as transfers, standing, and walking.
Physical therapy can also include specific stretches to relax muscles and prevent tendons from shortening, thereby reducing muscle stiffness and improving range of motion. Therapeutic modalities such as ultrasonography, electrical stimulation, and biofeedback can be used in conjunction with physical therapy to enhance its effectiveness. Temporary casts or braces may also be employed to support the treatment process.
The combination of physical therapy with other treatments, such as oral medication, injections, or surgery, is often employed to provide the most benefit to patients. The specific treatment plan will depend on the location and severity of spasticity, as well as the individual's overall health and goals. It is important to work with a team of healthcare professionals, including physical therapists, to determine the most appropriate treatment regimen.
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Spasticity can be treated with surgery
Spasticity is a disruption in muscle movement patterns that causes certain muscles to contract all at once. It can affect movement and speech. It is an increase in muscle tone typically related to a neurological condition, such as stroke, spinal cord injury, cerebral palsy, multiple sclerosis, or a brain injury. Spasticity can vary greatly in how it affects someone—it may be as mild as the feeling of tightness of the muscles or may be so severe that it causes painful, uncontrollable stiffness and spasms of the extremities.
While there is no cure for spasticity, there are several treatment options that can help alleviate symptoms and improve quality of life. Treatment for spasticity begins with non-invasive, nonsurgical approaches. The most effective way to treat spasticity is with a team of healthcare professionals with different specialties, including neurologists, physiatrists, physical therapists, occupational therapists, speech and language pathologists, neurosurgeons, and orthopedic surgeons.
Orthopedic surgery is one treatment option for spasticity. This type of surgery deals with treating the consequences of spasticity on muscles, bones, and connective tissue. Another surgical option is selective dorsal rhizotomy (SDR), which is recommended for people with severe spasticity in their legs due to cerebral palsy. During this procedure, neurosurgeons cut the damaged nerves carrying sensory information from spastic limbs where they enter the spinal cord, leaving healthy nerves intact. SDR rebalances the electrical signals sent to the spinal cord by surgically cutting carefully selected nerve roots, decreasing muscle stiffness while maintaining other functions.
Intrathecal baclofen (ITB) therapy is another surgical treatment option for spasticity. This involves placing a pump in the abdomen that releases a steady dose of the medication baclofen directly into the spinal fluid through a catheter. This can lead to a significant reduction in spasticity and pain with a lower risk of drowsiness compared to taking baclofen orally.
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Frequently asked questions
Spasticity is a disruption in muscle movement patterns that cause certain muscles to contract all at once when trying to move or even at rest. It is a feature of altered skeletal muscle performance with a combination of paralysis, increased tendon reflex activity, and hypertonia.
Symptoms of spasticity include continuous muscle stiffness, spasms, and involuntary contractions, which can be painful. It can also cause difficulty in walking or performing certain tasks.
Spasticity is caused by damage to the nerve pathways that control muscle movement. This can be due to an injury to the central nervous system (the brain or spinal cord) or other congenital conditions affecting the brain, spinal cord, or nerves.
There are several treatment options for spasticity, including physical therapy, occupational therapy, speech therapy, casting or bracing, oral medications, and surgery. The treatment approach depends on the frequency, severity, and underlying condition causing the spasticity.
Spasticity can affect muscles in any part of the body but is most commonly found in the leg muscles.
