Spasticity is a movement disorder observed in individuals with lesions of the upper motor neurone pathways, for example, in stroke, multiple sclerosis or spinal cord injury. Severe multifocal and regional muscle overactivity. Discuss the various presentations and outline functional outcome measures. For a clinician, the term spasticity may have a broad meaning, sometimes synonymous with upper motor neuron syndrome. This video is a part of a larger group of videos that were created during the symposium. These include reciprocal 1a interneuronal inhibition, presynaptic inhibition, renshawmediated recurrent inhibition, group ii afferent inhibition, and golgi tendon organs. Whenever a muscle is stretched, the excited spindles cause reflex contraction of the same muscle and also the synergistic muscles.
Spasticity, a classical clinical manifestation of an upper motor neuron lesion, has been traditionally and physiologically defined as a velocity. Spasticity usually requires both pharmacological and nonpharmacological interventions figure 1. Clinically spasticity manifests as an increased resistance offered by muscles to passive stretching lengthening and is often associated with other. Treatment should be done with firm and constant manual contact positioned over nonspastic areas to avoid stimulating the spastic muscles. Any mechanism or pharmacological drug suppressing increased reflexes and muscle tone is also prone to block the clonus 2. Assessment of spasticity judith fm fleuren university of. Spasticity mostly occurs in disorders of the central nervous system cns affecting.
A detailed discussion of these mechanisms is beyond the scope of this handout. However, the relation between the two remains poorly understood among clinicians. They also observed that spasticity primarily affects the elbow 79% of patients, the. Spasticity is a feature of altered skeletal muscle performance with a combination of paralysis. Nerve blocks with aqueous phenol khalili and colleagues in 1960s. Thus, the underlying mechanism for spasticity remains controversial. Spasticity and weakness spastic paresis are the primary motor impairments after stroke and impose significant challenges for treatment and patient care. The central lesion causing the umns disrupts the balance of supraspinal inhibitory and excitatory inputs directed to the spinal cord, leading to a state of disinhibition of the stretch reflex.
Spasticity is the uncontrolled tightening increased muscle tone caused by. Spasticity is defined as a motor disorder characterized by an involuntary, velocitydependent increase in muscle tone hypertonicity that is associated with neurologic conditions or injury to the brain or spinal cord. Spasticity and clonus result from an upper motor neuron lesion that disinhibits the tendon stretch reflex. Mar 27, 2019 spasticity is a condition in which there is an abnormal increase in muscle tone or stiffness of muscle, which might interfere with movement, speech, or be associated with discomfort or pain. Spasticity is usually caused by damage to nerve pathways within the brain or spinal cord that control muscle movement. Botulinum toxin type a in the treatment of upper extremity spasticity a randomized, double. Movement, either passive or active, is essential at all stages of management maintaining muscle length through passive or active exercise and stretching regimens including standing or splinting can be key to managing spasticity both in the short and the long term. Clonus does not occur if the muscle is excessively hypertonic 2. Spasticity versus rigidity stanford 25 skills symposium.
Stretch reflex is important for movement control, in normal condition, which incorporates with other spinal reflex by cortex premotor and supplementary areas to maintain its human balance and posture. The aim of this study was the assessment of spasticity in the lower extremities using the pedaling mechanism of a cycling system for paraplegics 4 and to quantify the influence of cycling training with fes on spasticity in sci. Understand the natural history and progression of spasticity including the various etiologies and sequelae. Spasticity is classically defined as a motor disorder characterized by a velocitydependent increase in tonic stretch reflexes 36. Damage to nerves in the central nervous system can disrupt the pattern. When you try to move a limb, the muscles contract shorten or flex.
This is our first video release from our 2015 stanford 25 skills symposium. Spasticity is disruption in muscle movement patterns so that muscles contract all at once. Research article muscle spasticity associated with reduced. The definition of spasticity proposed by lance1 states that spasticity is a form of muscle overactivity due to a. Spasticity and motor recovery are both related to neural plasticity after stroke. Spasticity is the only type of muscle overactivity easily quanti. Frontiers spasticity mechanisms for the clinician neurology. Mukherjee and chakravarty spasticity mechanisms for the clinician muscle stretch reflex myotatic reflex is the function of the muscle spindle. Management is dependent on the presentation and goals of treatment. Consequences of spasticity can include the development of contractures or chronic pain, functional problems with selfcare and mobility, seating problems, difficulty sleeping, as well as cosmetic appearance problems. Outcomes in spasticity after repetitive transcranial magnetic. Apr 26, 2016 pathophysiology of spasticity is not completely understood.
Spasticity, a classical clinical manifestation of an upper motor neuron lesion, has been traditionally and physiologically defined as a velocity dependent increase in muscle tone caused by the. People with spasticity may feel as if their muscles. Dec 17, 2010 it is likely that spasticity is not caused by a single mechanism, but rather by an intricate chain of alterations in different interdependent networks. Spasticity emerges and disappears in the course of complete motor recovery. Muscle movements are normally controlled by a complex system that allows some muscles to contract tighten while others relax. Neurophysiological mechanisms of spasticity modification by. The mechanism of spasticity is commonly thought as exaggerated stretch reflex.
Clonus does not occur if the muscle is exce ssively hypertonic 2. Spasticity, although difficult to define precisely, is a clinical condition that has been described as a motor disorder characterized by velocity dependent increase in tonic stretch reflexes muscle tone with exaggerated tendon jerks, resulting from hyperexcitability of the. The mechanisms underlying this disorder, however, are not well understood. How intrathecal baclofen therapy may help to manage your spasticity. Pdf spasticity mechanisms for the clinician researchgate. Spasticity mostly occurs in disorders of the central nervous system cns affecting the upper motor neurons in the form of a lesion, such as spastic diplegia, or upper motor neuron syndrome, and can also be present in various types of multiple sclerosis, where it occurs as a symptom of the progressivelyworsening attacks on myelin sheaths and is thus unrelated to the types of spasticity. Spasticity is a side effect of paralysis that varies from mild muscle stiffness to severe, uncontrollable leg movements. Pathophysiological mechanisms of spasticity at the spinal cord.
Considerations in the treatment of spasticity with. Spasticity is the uncontrolled tightening or contracting of the muscles that is common in individuals with spinal cord injuries. Spasticity can range from relatively mild to quite severe, and treatment is approached in a stepwise fashion rehabilitative pt. Spasticity affects more than 12 million worldwide specific to type and severity of cns injury 6590 % of cerebral palsy 6578 % of spinal cord injury 556 % of cerebrovascular accidents prevalence vary depending on etiology 80% affected with ue impairment 6 months after cva lang, 2009, archives epidemiology of spasticity. It may occur in association with spinal cord injury, multiple sclerosis, cerebral palsy, or brain. Spasticity mechanisms for the clinician article pdf available in frontiers in neurology 149.
Spasticity versus rigidity stanford 25 skills symposium, 2015 can you differentiate between spasticity versus rigidity. Influence of fes cycling on spasticity in subjects with. Chapter 4 stop using the ashworth scale for the assessment of spasticity. About 65%78% of the sci population have some amount of spasticity, and it is more common in cervical neck than thoracic chest and lumbar lower back injuries.
Spasticity can be a significant problem in upper motor neuron disorders. Variation in reflex gain over the time course of spasticity. It is only one of the several components of the upper motor neuron syndrome umns. Comprehensive multidisciplinary approach and coordination of care is most important. Generally, doctors now call conditions of extreme muscle tension spastic hypertonia sh. Adjustment in dosages or addition of other anti spasticity medications may successfully reduce tone. Spinal mechanism concerning changes in the functioning of the spinal neurons and motor subsystems.
Leads to immobilization, muscle shortening, contracture, disuse, functional decline. Highlights of prescribing information pediatric lower limb. Spasticity is the velocitydependent increase in muscle tone due to the exaggeration of stretch reflex. Nerve blocks with aqueous phenol khalili and colleagues in 1960s phenol motor point blocks halpern and. Spastic hypertonia has been defined as a motor disorder characterized by a velocitydependent increase in tonic stretch reflexes muscle tone with exaggerated. Define and differentiate spasticity from other neurological conditions associated with increased tone. Muscle spasticity interferes with mobility, transfer, selfcare, and activities of daily living, and has a negative impact on wellbeing. In the pathophysiology of spasticity and spastic paretic syndrome there are two broad categories of interrelated influencing mechanisms namely. The fact that there is a period of shock, followed by a transition period when reflexes return, but are not hyperactive suggests that this is not just simply a question of switching off.
Phenol in spasticityhistory earliest use of phenol for spasticity by intrathecal route nathan, 1959 and kelly, gautiersmith, also 1959 simultaneously reported intrathecal injections for relief of spasticity. Thus, smd represents the different determinants of pathological movement patterns in patients with spasticity in a more comprehensive way. Sep 01, 2009 spasticity is defined as a motor disorder characterized by an involuntary, velocitydependent increase in muscle tone hypertonicity that is associated with neurologic conditions or injury to the brain or spinal cord. Spasticity, motor recovery, and neural plasticity after stroke. Phenol blocks focal spasticity effect lasting 912 months technically difficult procedure 15% dysesthesias. Severe clonus can interrupt sleep and prevent the transfer capability of the patient and result in. An experimental study of cerebellar dyskinesia in the rhesus monkey. Spasticity is a motor disorder affecting 12 million people worldwide, in which upper motor neuron lesions result in continuous, increased tonic stretch reflexes. Spasticity also causes the tendons and soft tissue around the muscle to become tight or stiff. However, the onset of spasticity is highly variable and can occur in the short, medium or longterm poststroke period 7. Spasticity, a classical clinical manifestation of an upper motor neuron lesion, has been traditionally and physiologically defined as a velocity dependent increase in muscle tone caused by the increased excitability of the muscle stretch reflex. Aug 23, 2018 although spasticity is a condition involving unusual tightness of muscles in the body, the cause typically originates from an injury to or disorder of the central nervous system cns. Eighteenyears after baclofen was first synthesized, norman bowery identified the receptor involved in its.
Spasticity evaluation of hemiparetic limbs in stroke patients. This makes stretching the muscle much more difficult. The term spasticity is used in a variety of circumstances describing impaired movement execution, enhanced muscular resistance against passive movement. Pdf spasticity, a classical clinical manifestation of an upper motor neuron lesion, has been traditionally and physiologically defined as a. Rehabilitation procedures in the management of spasticity. As a result, many muscles may contract all at once.