Spasticity：Symptoms, Causes and Treatment
Overview
Spasticity is a muscle control disorder accompanied by tight or stiff muscles, which can interfere with normal movement, walking and speech. It occurs due to a disruption in communication between the brain and the muscles. In spasticity, the muscles simply contract and the reflexes tend to be stronger or exaggerated.
Some degree of spasticity can provide benefits, particularly for people who experience significant leg weakness, because spasticity gives their legs rigidity, making it easier for them to stand, transfer, or walk. But spasticity also negatively affects muscles and joints of the extremities and is particularly harmful to growing children. It may be aggravated by sudden movements or position changes, as well as extremes of temperature, humidity or infections, and can even be triggered by tight clothing.
The CDC estimates that the annual incidence of SCI in the US is approximately 11,000. Nearly 200,000 Americans currently live with a disability related to an SCI.
Symptoms
People with spasticity may feel as mild as tightness in muscles and also the conditions may be severe enough to produce painful, uncontrollable spasms of the extremities, especially in arms and legs. Generally, spasticity causes stiff muscles, rigid joints, pain and even immobility. Sometimes, it is possible for patients to feel hard to bend or straighten their arms, legs, wrists, ankles or fingers. Common signs and symptoms of spasticity include:
- Increased muscle tone
- Overactive reflexes
- Muscle fatigue
- Pain and pressure sores
- Fever or other systemic illnesses
- Involuntary movements, such as spasms and clonus
- Decreased functional abilities and delayed mobility
- Difficulty with care and hygiene
- Abnormal posture
- Contractures
- Bone and joint deformities
Causes
Spasticity is caused by the imbalance of signals from the central nervous system to muscles. This imbalance is often found in people with cerebral palsy, stroke, multiple sclerosis, traumatic brain injury, and spinal cord injury. All in all, there are various causes that may potentially lead to spasticity:
- Cerebral palsy
- Stroke
- Multiple sclerosis
- Brain damage caused by lack of oxygen
- Head or spine injury
- Adrenoleukodystrophy
- Phenylketonuria
- Neurodegenerative illness
- Rare metabolic disorders
Diagnosis
Spasticity is a clinical sign associated with some distinct neurological diseases, causing spasms and pain. Therefore, people with spasticity need timely diagnosis and management to prevent contracture of the muscles and damaged tissues, which may lead to deformity of the limbs and bones.
Doctors may ask for a comprehensive medical history followed by an analysis of posture, movement control, muscular strength, coordination, endurance and spasticity for assessment.
There are some other diagnostic tests. For example, electromyography may be used to determine specific nerve conduction velocities, which can help guide diagnosis. Besides, diagnostic imaging techniques such as Magnetic Resonance Imaging (MRI) may be used to visualize changes to the head, neck, and spine and identify possible causes for muscular symptoms.
Treatment
Spasticity needs treatment when it causes pain, interferes with daily activities such as sleeping or leads to less ability to function. There are a variety of treatments for spasticity including non-surgical and surgical ones, depending on the underlying cause, the age of the patient and the severity of the symptoms. The common treatments include:
- Physical and occupational therapy
It can reduce muscle tone, maintain or improve mobility, increase strength and coordination and make the patient feel more comfortable. Such therapy may include stretching and strengthening exercises, temporary braces or casts, limb positioning, application of cold packs, electrical stimulation and biofeedback.
- Oral medications
If the symptoms interfere with daily living and functioning, oral medications are recommended. Effective medication may require the use of two or more drugs or a combination of oral medications with other types of treatment. It is advisable to see a doctor to make an individualized treatment plan for side effects vary greatly by class of medication and patient. Medications for spasticity include:
If patients experience severe and unbearable symptoms, they can resort to surgical treatments, which include:
- Intrathecal baclofen therapy (ITB), is used to treat the severe degree of spasticity. Patients must undergo an ITB screening test before having a pump placed.
- Orthopedic surgery, or surgery that deals with treating muscles, bones, and connective tissue.
- Neurosurgery, or surgery that deals with treating the brain, spinal cord, and nerves.
Keywords: spasticity.
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