Spasticity

SPASTICITY


 INTRODUCTION:
 Spasticity is an abnormal increase in the tone of the muscle.It is a motor disorder characterised by hypertonia and velocity-dependent resistance to passive stretch.It is seen secondary to various disorders like stroke , cerebral palsy,etc.


 CHARACTERISTICS: 
Spasticity is velocity-dependent. So,the larger and quicker the stretch, the stronger is the resistance of the spastic muscle .It is seen only in one muscle group, either agonist or antagonist.
 During a rapid passive movement or stretch,initial high resistance or catch by the muscle , can be followed by a sudden letting-go or relaxation of the limb.This phenomena is called 'clasp-knife response'
 Spasticity is a state of 'hyperactivity' or exaggeration of the normal stretch reflex.
 It usually follows the Upper Motor Neuron lesions which include conditions like stroke, head -injury, cerebral palsy, multiple sclerosis,etc.
 The impairment of the following structures lead to spasticity- cerebral cortex, mid brain, brain stem, cerebellum and spinal cord.


 PATHOPHYSIOLOGY: The higher cortical centre (brain ) has an inhibitory control over the lower centres (skeletal muscles).
Spasticity arises from any injury to the higher cortical centre.
 Hence, there is an abnormality or inhibition of the 'supra-spinal' input . This leads to acute spasticity . Whereas, chronic spasticity may be associated with disability, abnormal posture and contracture formations.


 CLINICAL FEATURES:
 hyperactive stretch reflexes
 involuntary flexor and extensor spasms
 clonus
 babinski's sign 
exaggerated cutaneous reflexes
 dysseynergic patterns
 loss of precise autonomic control
 abnormal posture
 presence of primitive reflexes like ATNR, STNR ,TLR ,etc


 MANAGEMENT:
 1.POSITIONING:
 proper positioning of the limbs is necessary because chronic spasticity can be a result of improper positioning. 
Upper limbs should be placed in extension as they tend to adapt flexor synergy pattern.
 Lower limbs should be placed in slight flexion as they tend to adapt extensor synergy pattern. 
The neck should be neutral and supported.
 Various positioning interventions can be used, like prolonged positioning on a tilt-table, or low load weights applied using skin traction , etc. 


2.CRYOTHERAPY: Ice packs or wraps can be applied. Cool immersion bath (hydrotherapy) can be effective before starting the intervention.
 This temporarily reduces the spasticity by slowing the conduction of impulses in nerves and muscles. 
This is contra-indicated in patients with increased heart rate, respiratory rate and also nausea.


 3.SLOW SUSTAINED STRETCHING:
 Intermittant static stretch held for 30-60 seconds can be repeated 7-10 times per session.
 Maintained stretch for 30 minutes to 2 hours reduces stretch reflex activity.
 Stretch can be combined with gentle slow rhythmic rotation of the part.PNF techniques can also be used.
 A skeletal muscle relaxant like baclofen given during thee sessions is proved useful.


 4. ACTIVE EXERCISES:
 Should be performed slowly,at the available range only.
 Contraction of the antagonist, leads to reciprocal-inhibition of the agonist (spastic group) and helps to reduce spasticity.
 Mat exercises should be given.


 5.MYOFASCIAL RELEASE: it helps to reduce spasticity and induces relaxation.


 6.ELECTRICAL STIMULATION:This is given to the antagonistic group of muscles to decrease spasticity in agonists.


 7.LOWER TRUNK ROTATION: done in side lying or hook lying can reduce the extensor tone. 


8.BRACE OR SPLINTS : resting splints , toe/ finger spreader, ankle splint , etc are useful to maintain the positions of joints. 


9.OTHERS:
 Relaxed passive movements 
 Reflex inhibitory movement patterns
 Rood's approach


 Muscles prone to spasticity are Quadriceps, adductors and plantar flexors , so they should be given more attention.