Spasticity clinics include rehabilitation physicians, physiotherapists and occupational therapists. They can provide comprehensive assessment and advise you on managing spasticity over the long term. Muscle spasticity will tend to get worse the less you move. This is especially true if the muscles become weaker. Moving less can also contribute to developing contracture. It is important to move as much as possible. Join an exercise group or ask your family and friends to help you practise doing things and to move more.
Email strokeline strokefoundation. To find a neurological physiotherapist: Australian Physiotherapy Association choose. To find an occupational therapist: Occupational Therapy Australia otaus. For more information visit the EnableMe resource topics on Arm and hand function and Leg functioning.
Where am I? Home What we do For survivors and carers After stroke fact sheets Muscle spasticity after stroke fact sheet. Muscle spasticity after stroke fact sheet What you need to know High tone or activity in your muscles makes them feel stiff and tight.
Your treating team can work with you to develop a treatment plan. How stroke causes spasticity Muscles have a certain amount of tone, or activity. Effects of muscle spasticity Muscle spasticity can cause: Stiffness in the fingers, arms or legs Muscle spasms Overactive reflexes Uncontrollable rhythmic contractions and relaxations in the muscles that lead to jerking.
This is called clonus. Nerve pathways that connect your brain, spinal cord and muscles, work together to coordinate smooth movement. If nerve signals between a muscle and the brain are interrupted by damage caused by MS, the muscle can remain in its shortened state, making the affected limb feel stiff or tight and often difficult to move. If a limb becomes fixed in one position it is known as a contracture. Disrupted nerve messages can also cause over activity of muscles and loss of coordination leading to spasms.
Depending on where in your brain or spinal cord MS affects nerves, spasticity can affect any muscle in the body. Most people will only experience occasional symptoms. About one in five people reported that spasticity and spasms frequently affected their activities and one in eight described their symptoms as severe.
In this video we asked Katrina Buchanan, a consultant physiotherapist, to talk to us about the drug treatments, trigger factors and types of exercise that can help manage spasticity and spasms.
Key to managing the negative effects of your spasticity and spasms is the need for movement or stretching and being aware of potential trigger factors that might make the symptoms worse. It is important to keep muscles, ligaments and joints as flexible as possible. This can be done through stretching, active movement where you move your own limbs or passive movement where your limbs are moved by a carer, physiotherapist or automated exercise machine.
A physiotherapist can advise on how best to maintain flexibility, teach specific stretches that you can incorporate into your daily routine and ways of moving and positioning your body to prevent contractures. Read more about exercises for people with MS. Maintaining good posture is also important, whether standing, sitting or lying down. Physiotherapists can advise you on posture. An occupational therapist can help you find adapted seating, aids to improve sleep positions and seating posture, and advise on safe use of wheelchairs.
Read more about posture. Managing the trigger factor, maintaining good posture and incorporating stretches into your daily routine can help reduce the effects of spasticity or spasm without needing any medication. If you are taking medication, it will not be fully effective unless any trigger factors for spasticity are also being addressed.
Read more about spasticity triggers. Using drugs to treat spasticity and spasms effectively is a balance between reducing stiffness and not reducing strength in a muscle. If you remove all of the spasticity from a limb, the muscles may be too weak to work properly. For instance, if you have spasticity in your leg, the stiffness may help to keep it rigid enough to help you walk. If all of the stiffness is removed, the muscles might be too weak to hold you up.
There are a number of medications for spasticity. NICE's clinical guideline on the management of multiple sclerosis says that the first line of treatment should be with baclofen or gabapentin. If either of these isn't helping, a combination of the two drugs may help. If not, tizanidine or dantrolene are other possible treatments to try. Pregabalin , diazepam and clonazepam are also sometimes used to treat spasticity and spasms.
Treatment usually starts with a low dose and gradually increases until a level is reached that helps you best. It is important that you consider when you take them during the day to maximise their effect.
For instance if you struggle to get up, washed and dressed, taking your medication minutes before you get out of bed may ease the effort of your morning routine. If you need some stiffness in your legs to help you get out of bed safely, you may prefer to take your treatment after you have got up. Sativex is a cannabis-based mouth spray that is licensed for the treatment of MS spasticity.
Sativex is not widely available on the NHS, other than in Wales where the drug regulator has approved treatment. It can be prescribed by a specialist doctor. If no improvement is seen within 4 weeks, treatment will be stopped, as only around half of people respond to Sativex. If the spasticity affects only part of your body botulinum toxin may be helpful. Botulinum toxin botox is injected into muscles and temporarily weakens them for about three months. During this period a physiotherapist can advise you on moving and stretching exercises that you can do to reduce the effects of spasticity in the longer-term.
Intrathecal baclofen therapy involves having surgery to place a small pump in your abdomen. The pump delivers baclofen through a fine tube called a catheter into the fluid space around your spinal cord called the intrathecal space. The pump uses much smaller doses of baclofen than when you it take it as tablets and so causes fewer side effects. Treatment with phenol is usually only used if you have severe spasticity that hasn't responded to other treatments.
Phenol is given via a lumbar puncture into the space around the spinal cord. Intrathecal phenol is an irreversible, destructive treatment that permanently stops nerve messages. This can greatly reduce spasticity in the legs but may also reduce skin sensation, affect sexual function and alter how your bladder and bowel work. If your doctor is considering treatment with phenol, you will already be aware of these symptoms and may have a urethral or suprapubic catheter , a skin management programme to avoid pressure ulcers or be using suppositories regularly.
Arjan van der Salm, a researcher from the Netherlands who wrote his doctoral dissertation on managing spasticity with electrical stimulation, provides a great analysis in his journal paper published in [3]. He demonstrated that electrical stimulation does not reduce spasticity , but it does relax spasms , meaning that the muscle will spasm less for a period of time, usually for several hours after stimulation.
This can be achieved by either stimulating the spastic muscle itself or by stimulating its antagonist. Van der Salm showed that stimulating the spastic muscle itself was most effective in relaxing spasms, probably because the stimulation fatigues the muscle and improves blood circulation to the muscle.
The takeaway here is that electrically stimulating a muscle can prevent spasms for several hours afterward, so it can be used as needed to manage spasticity. There are many different factors to consider when choosing how to manage spasticity. The cause of spasticity, your situation and medical condition, and other factors like financing and support can all affect your decision.
At the end of the day, a combination of methods will probably be best. For example, many people are fine with a low dose of medications combined with regular stretching and strengthening. If you know someone who could use some help in managing spasticity, please share this article with them using the social media links at the top of the post. The MyoCycle combines electrical stimulation with range of motion and strengthening exercise and is cleared by the FDA for general rehab for:. WebMD: Spasticity.
Cleveland Clinic: Spasticity. National MS Society: Spasticity. MedlinePlus: Caring for muscle spasticity or spasms. CareCure: FAQ about implanted drug pumps for managing spasticity. Spasticity: clinical perceptions, neurological realities and meaningful measurement. The SCIRehab project: physical therapy treatment time during inpatient spinal cord injury rehabilitation. The Journal of Spinal Cord Medicine ; 34 2
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