BLOG POST: Comprehensive Management and Treatment Options for Spasticity: A Guide for Patients and Caregivers
BY ANDY K
Consult your healthcare professional to determine the best treatment option for managing spasticity, taking into account your goals, the severity of your spasticity, and your overall health. Proper assessment and diagnosis are critical for developing an effective treatment plan, and continuous evaluation is necessary to monitor progress and outcomes.
About 25 to 43% of survivors will have spasticity in the first year after their stroke. It's more common in younger stroke survivors. It's also more common when the stroke is caused by a bleed (hemorrhagic).
Treatment Options:
1.Physical Exercise and Stretching:
Stretching: Helps maintain full range of motion and prevents permanent muscle shortening. Regular stretching can also reduce muscle stiffness and improve flexibility.
Exercise: Physical activity tailored to the individual's abilities can strengthen muscles, enhance coordination, and improve overall mobility.
2.Botulinum Toxin Injections:
Injections: Medications like botulinum toxin can be injected to block nerve signals, relieving spasticity in specific muscle groups by weakening or paralyzing overactive muscles. Injections are typically administered every 3-6 months. Side effects are minimal and usually limited to soreness at the injection site.
3.Oral Medications:
Medications: These can help relax nerves to prevent continuous muscle contraction. Commonly prescribed medications include baclofen, tizanidine, and diazepam. Potential side effects may include weakness, drowsiness, or nausea, so dosage adjustments may be necessary to balance effectiveness and side effects.
4. Functional Electrical Stimulation/Neuromuscular Electrical Stimulation (NMES):
NMES: Delivers electrical shocks to the affected muscle, activating nerves and stimulating movement. The intensity of the shock can range from a mild tingling sensation to a more intense burning sensation. NMES combined with physical therapy may improve spasticity, though there is insufficient evidence to confirm significant improvements in functional gait or hand use.
5. Intrathecal Baclofen Therapy (ITB):
ITB: Provides targeted delivery of baclofen to the spinal cord via a surgically implanted pump, reducing side effects commonly associated with oral medications. This treatment is suitable for patients who have not responded well to other interventions or who have experienced adverse reactions to oral medications.
6. **Braces and Splinting**:
Braces: These devices help maintain normal muscle position to prevent contraction. They can be particularly useful for stabilizing joints and maintaining functional positions.
Serial Casting and Splinting: Although generally not recommended for reducing wrist and finger spasticity, serial casting may be considered for mild to moderate elbow and wrist contractures. This approach involves the application of a series of casts to gradually stretch and lengthen muscles and tendons.
7. Surgical Procedures:
Surgery: Considered for severe contractures and associated pain that do not respond to other treatments. Surgical options may include tendon release, muscle lengthening, or nerve surgeries to reduce spasticity and improve limb function.
Impact of Spasticity:
Spasticity can significantly interfere with daily activities such as bathing, eating, and dressing, increasing caregiver burden and reducing quality of life. Between 25% and 43% of stroke survivors experience spasticity within the first year, with higher prevalence in younger survivors. Spasticity can also lead to complications such as joint deformities, skin breakdown, and pain, further affecting the individual's quality of life and ability to perform daily tasks.
Common Symptoms of Spasticity:
- Painful muscle spasms: Involuntary contractions that can be intense and painful, often disrupting sleep and daily activities.
- Difficulty stretching the muscle: Resistance to passive movement, making it hard to fully extend or flex the affected limb.
- Stiffness in the arm, hand, leg, and ankle: Increased muscle tone leading to rigid muscles that are hard to move.
- Arm folded against the chest with curled wrist and fingers: A common postural pattern in upper limb spasticity.
- Tight fist: Involuntary clenching of the hand, making it difficult to grasp or release objects.
- Pointed foot: Plantar flexion contracture, causing the toes to point downward and making walking difficult.
- Curled toes: Flexion contracture of the toes, contributing to balance and walking problems.
- Bent elbow: Flexion contracture of the elbow, limiting arm movement.
- Decreased function: Overall reduction in the ability to perform daily activities and participate in social and recreational activities.
- Overactive reflexes: Hyperreflexia, where normal reflexes become exaggerated, leading to uncontrolled muscle spasms and movements.
Comprehensive Management:
Managing spasticity often requires a multidisciplinary approach, involving neurologists, physiatrists, physical therapists, occupational therapists, and orthopedic surgeons. Personalized treatment plans should be developed to address the unique needs and goals of each individual, aiming to improve function, reduce pain, and enhance quality of life.
Additional Considerations:
Patient Education: Educating patients and caregivers about spasticity, its effects, and management strategies is crucial for effective treatment adherence and self-care.
Psychological Support: Addressing the emotional and psychological impact of spasticity is important, as it can affect mental health and overall well-being. Counseling and support groups can provide valuable resources.
Adaptive Equipment: Utilizing adaptive equipment such as modified utensils, dressing aids, and mobility devices can help individuals maintain independence and improve their ability to perform daily tasks.
By adopting a comprehensive, individualized approach to spasticity management, healthcare providers can help patients achieve better outcomes and improve their overall quality of life.
Spasticity progresses through several stages, which are typically categorized using the Modified Ashworth Scale or other similar clinical scales. These stages describe the increasing severity of muscle tone and reflex responses. Here are the stages of spasticity:
STAGES OF SPASTICITY
1. Stage 1: Minimal Spasticity
- **Description**: Muscle tone is slightly increased, manifesting as a catch and release or by minimal resistance at the end of the range of motion when the affected part is moved in flexion or extension.
- **Symptoms**: Slight resistance during passive movement, mild stiffness in the muscles, minimal functional impairment.
2. Stage 2: Moderate Spasticity
- **Description**: Increased muscle tone through most of the range of motion, but affected parts are still easily moved.
- **Symptoms**: More noticeable resistance during passive movement, moderate stiffness, and increased difficulty in performing certain tasks.
3. Stage 3: Severe Spasticity
- **Description**: Considerable increase in muscle tone, making passive movement difficult.
- **Symptoms**: Significant resistance to passive movement, marked stiffness, more pronounced impact on functional activities, and potential pain or discomfort.
4. Stage 4: Very Severe Spasticity
- **Description**: Affected parts are rigid in flexion or extension, leading to very limited movement.
- **Symptoms**: Severe resistance to movement, substantial impairment in function, possible joint contractures, and significant pain.
Clinical Scales for Assessment:
- **Modified Ashworth Scale**: Widely used to measure spasticity. It rates the increase in muscle tone with a scale from 0 (no increase in muscle tone) to 4 (affected part rigid in flexion or extension)【24†source】.
- **Tardieu Scale**: Measures the angle of muscle reaction and distinguishes between contracture and spasticity by assessing the response at different velocities.
Management Considerations:
**Early Stages**: Focus on physical therapy, stretching, and possibly oral medications to manage symptoms and maintain range of motion.
**Moderate Stages**: May require more intensive therapies, such as botulinum toxin injections, functional electrical stimulation, and adjustments to medications.
**Severe Stages**: Involvement of intrathecal baclofen therapy (ITB), surgical interventions, and more extensive use of adaptive equipment and braces to manage contractures and maintain mobility.
Understanding these stages helps in tailoring appropriate interventions and monitoring the progression of spasticity to optimize patient outcomes.
NEW TREATMENTS
Recent developments in the treatment of spasticity have introduced several promising options. One of the notable advancements is the drug candidate MPH-220, which specifically targets skeletal muscle myosin. This drug has shown potential in preclinical studies to effectively reduce spasticity by selectively inhibiting the motor proteins involved in muscle contraction, providing a safer and more targeted approach to treatment.
Another significant development is the use of non-invasive brain stimulation techniques, such as repetitive transcranial magnetic stimulation (rTMS). This method aims to modulate cortical excitability and improve motor function by delivering magnetic pulses to specific brain regions. rTMS has shown promise in reducing spasticity and improving movement in patients with neurological conditions.
Additionally, advancements in understanding the corticospinal tract's role in spasticity have led to new therapeutic strategies. Researchers are exploring ways to enhance the function of the corticospinal tract, which connects the brain's motor cortex to the spinal cord and plays a critical role in voluntary muscle movement. Therapies targeting this pathway may help improve motor control and reduce spasticity in patients with post-stroke conditions.
These new treatments, alongside traditional methods such as physical therapy, botulinum toxin injections, and oral medications, offer a broader range of options for managing spasticity and improving patients' quality of life.
………………………………………………………………………………………………………………………….
Exciting News:
I’m also developing a brand-new font! Working with a talented team, we're combining many ideas and overcoming numerous challenges to bring this creative project to life. From ensuring design consistency and readability to tackling software compatibility issues, the journey has been both exciting and demanding.
Our goal is to create a font that is not only visually appealing but also highly functional across different platforms and applications. We’re experimenting with various styles and typographic elements to ensure that the final product meets a high standard of excellence.
Moreover, the font development process has been a wonderful collaborative effort. We've had brainstorming sessions filled with creativity, problem-solving meetings to address design and technical challenges, and a lot of iterative testing to refine the font. I can’t wait to share more about our progress and the unique features of this new font in upcoming newsletters.
Stay tuned for updates, sneak peeks, and perhaps even a few behind-the-scenes stories about our journey!
QUESTIONS --- COMMENTS??
Please note that STROKENEWSLETTER.NET is operated by a stroke survivor and is not managed by a licensed medical professional. All stroke therapies and rehabilitation methods mentioned should only be performed under the supervision and guidance of a qualified healthcare provider. Always consult with your doctor or a certified medical professional before starting any new treatment or therapy regimen.
