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Spasticity is a symptom of certain neurological conditions, causing muscles to contract all at once, disrupting movement patterns and affecting speech and gait. It is characterised by increased, involuntary muscle tone, causing resistance to movement, and can range from mild tightness to painful, uncontrollable stiffness and spasms. Spasticity can be caused by damage to the brain, spinal cord, or motor neurons, and can affect muscles in any part of the body, though it is most common in the legs. Treatment options include physical therapy, medication, and surgery, with the goal of improving comfort, mobility, and independence.
| Characteristics | Values |
|---|---|
| Definition | A disruption in muscle movement patterns that causes certain muscles to contract all at once. |
| Cause | Damage or disruption to the area of the brain and spinal cord that are responsible for controlling muscle and stretch reflexes. |
| Symptoms | Continuous muscle stiffness, spasms, involuntary contractions, pain, difficulty walking or performing certain tasks. |
| Treatment | Physical therapy, medication, surgery, casting or bracing, botulinum toxin injections, ITB pump, rhizotomy. |
| Prevalence | Affects over 12 million people worldwide, including approximately 80% of people with cerebral palsy and 80% of those with multiple sclerosis. |
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What You'll Learn
Causes of spasticity
Spasticity is a disruption in muscle movement patterns that causes certain muscles to contract all at once, either when at rest or when trying to move. It can affect movement and speech and may cause painful, uncontrollable stiffness and spasms. The condition varies in severity, ranging from mild muscle tightness to severe spasms.
Spasticity is generally caused by damage or disruption to the brain and spinal cord, which control muscle and stretch reflexes. This includes damage from degenerative diseases or physical injuries. Some possible causes of spasticity include:
- Spinal Cord Injury (SCI): Injuries to the spinal cord can disrupt its function, potentially resulting in temporary or permanent changes that cause muscle overactivity.
- Multiple Sclerosis (MS): MS damages the myelin sheath, the protective covering of brain and spinal cord nerve fibres.
- Cerebral Palsy: This group of disorders affects movement and coordination and originates from damage to the developing brain, typically before birth.
- Stroke: A stroke interrupts the blood supply to the brain, causing brain cells to die. The resulting damage can affect nerve pathways that control muscle tone, leading to spasticity.
- Brain or Head Trauma: Severe injuries to the brain can disrupt its ability to send proper signals to muscles, resulting in spasticity. This includes traumatic brain injury (TBI) and other forms of head trauma.
- Infections: Infections like meningitis or encephalitis that affect the brain or spinal cord can cause spasticity by inflaming or damaging areas controlling muscle movements.
- Metabolic Diseases: Conditions that disrupt metabolic processes can indirectly contribute to spasticity by impacting neurological function and muscle control.
- Imbalance in Electrical Signals: An imbalance in electrical signals to antagonist muscles can cause spasticity. Selective Dorsal Rhizotomy (SDR) is a procedure that rebalances these electrical signals by cutting selective nerve roots, reducing muscle stiffness.
The management of spasticity requires careful consideration, as some patients rely on aspects of it to maintain enough tone for functions such as standing or walking. Treatment options include physical therapy, medication, and botulinum toxin injections. While there is no cure for spasticity, these treatments can help manage symptoms and improve quality of life.
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Treatments for spasticity
Spasticity is a disruption in muscle movement patterns that causes certain muscles to contract all at once. While there is no cure for spasticity, there are several treatment options that can help alleviate symptoms and improve quality of life.
Physical Therapy
Physical therapy can include lower extremity stretching and strengthening exercises and mobility training (transfers, standing, and walking) to improve range of motion and mobility. Specific stretches and exercises are designed to relax muscles and prevent tendons from shortening.
Occupational Therapy
Occupational therapy focuses on improving strength and coordination in small muscle groups, allowing for improved performance of daily tasks.
Speech Therapy
Speech therapy may be beneficial for patients whose spasticity has affected their speech.
Medication
Oral medications can be used to treat spasticity, although they may have adverse effects, including sedation and changes in mood and cognition, especially at high dosages. Baclofen is a commonly used medication, although it must be used with care due to potential side effects such as sedation, ataxia, weakness, and fatigue, as well as the need to monitor liver function. Intrathecal baclofen therapy involves surgically placing a pump in the abdomen to release a steady dose of medication directly to the spine. This treatment has been found to be effective, especially in severe cases of spasticity in the lower extremities.
Injections
Injections, such as botulinum toxin or phenol, can be used to selectively reduce tone in muscles causing tightness or spasms. These injections improve the ability to stretch, decrease muscle pain, and improve gait and range of motion.
Surgery
Surgery may be considered in severe cases of spasticity. Selective dorsal rhizotomy (SDR) is a surgical procedure that involves cutting selective nerve roots to rebalance electrical signals sent to the spinal cord, thereby decreasing muscle stiffness while maintaining other functions. This procedure is typically used in patients with cerebral palsy and severe spasticity of the legs.
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Complications of spasticity
Spasticity is a neurological condition that causes abnormal muscle stiffness and contractions, impairing bodily functions and daily activities. While the severity of spasticity varies, there are several potential complications that can arise if left untreated or improperly managed:
Pain and Discomfort
Spasticity can cause mild to severe pain, ranging from a feeling of tight muscles to painful and uncontrollable spasms, especially in the legs and back. This pain can interfere with daily activities and impact an individual's quality of life.
Muscle Contractures
Untreated spasticity can lead to muscle contractures, where muscles become permanently shortened due to severe and persistent stiffness and spasms. This can affect an individual's posture, movement, and ability to perform daily tasks.
Joint Deformities
Spasticity can cause joint deformities, particularly in children with growing bones. The continuous muscle stiffness and spasms associated with spasticity can lead to painful and deformed joints, further impairing movement and function.
Inhibition of Longitudinal Muscle Growth
Spasticity can interfere with the normal growth of muscles, especially in children. This can lead to muscle weakness and further complications.
Urinary Tract Infections (UTIs) and Chronic Constipation
Without proper management, spasticity can result in urinary tract infections and chronic constipation, which can be painful and impact an individual's overall health and well-being.
Pressure Sores and Skin Complications
Prolonged spasticity can lead to pressure sores on the skin, causing pain and discomfort. Additionally, spasticity can affect skin care and hygiene, particularly in areas of fixed deformity contractures.
It is important to note that spasticity can be effectively managed through a combination of treatments, including physical therapy, medication, and surgery. A multidisciplinary team of healthcare professionals is often involved in developing a comprehensive treatment plan to address the various complications of spasticity and improve an individual's quality of life.
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Spasticity and speech
Spasticity is a disruption in muscle movement patterns that causes certain muscles to contract all at once. It can affect movement and speech. The muscles remain contracted and resist being stretched, thus affecting movement, speech and gait. The severity of spasticity ranges from mild feelings of muscle tightness to painful, uncontrollable stiffness and spasms.
Spasticity is generally caused by damage or disruption to the area of the brain and spinal cord that are responsible for controlling muscle and stretch reflexes. It is a symptom and characteristic of certain neurological conditions.
When spasticity affects speech, it is known as spastic dysarthria. This is a progressive speech disorder that can make it difficult for the patient to speak and be understood. Speech may be strained, slow, monotone, and nasal. There may be abnormally long pauses between words or syllables.
Speech therapy can be done by patients whose spasticity has affected their speech. Speech therapy can include exercises to strengthen the jaw, lips, and tongue to improve coordination during speech. A Speech/Language Pathologist (SLP) can evaluate, determine how to maintain vocal control, and help improve speech patterns, enunciation, breathing techniques, and communication in general.
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Spasticity and cerebral palsy
Spasticity is a disruption in muscle movement patterns that causes certain muscles to contract all at once, either when at rest or when trying to move. It can affect movement and speech. Spasticity is generally caused by damage or disruption to the area of the brain and spinal cord that are responsible for controlling muscle and stretch reflexes. It can range in severity from mild muscle tightness to painful, uncontrollable stiffness and spasms.
Spastic cerebral palsy (CP) is the most common type of cerebral palsy, affecting around 80% of people with CP. It is caused by brain damage or abnormal development in the areas of the brain responsible for controlling muscle movement, particularly the motor cortex. This damage causes muscle stiffness, tightness, and jerky, uncontrolled movements, which can result in mobility issues. The legs are most commonly affected, but it can also impact the arms, face, or the entire body. Children with spastic CP may have mild stiffness in just one hand or experience severe stiffness that makes it impossible to move some muscles at all. They may need help with eating and use a wheelchair for mobility.
The treatment plan for spastic CP may include physical therapy, occupational therapy, and speech therapy. Oral medications such as Valium and baclofen are sometimes used, but these are not typically considered effective in reducing spasticity. Botulinum toxin (Botox) injections can be used to paralyze the spastic muscle and prevent it from contracting. Selective dorsal rhizotomy (SDR) surgery is another option, which rebalances the electrical signals sent to the spinal cord by cutting selective nerve roots. However, it is important to note that there is currently no cure for cerebral palsy, and treatments focus on helping individuals grow and develop to their greatest potential.
The management of spasticity should be carefully considered, as some patients rely on aspects of spasticity to maintain enough tone for functions such as standing or walking. Planned interventions should consider a balance between movement and positioning. For example, standing promotes anti-gravity muscle activity in the trunk and lower limbs and helps maintain or improve soft tissue and joint flexibility.
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Frequently asked questions
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 is a symptom and characteristic of certain neurological conditions. It can affect movement and speech.
Spasticity can vary in severity, ranging from mild tightness in the muscles to painful, uncontrollable stiffness and spasms. Other symptoms include muscle spasms, clonus, involuntary crossing of the legs, pain or discomfort, abnormal posture, and difficulty performing daily activities.
There are several treatment options for spasticity, including physical therapy, medication, and botulinum toxin injections. Treatment goals include relaxing the muscles, relieving pain and stiffness, and improving muscle flexibility, range of motion, coordination, and strength. In some cases, surgery may be required.
