Stroke Patients: Can Tone Be Restored?

Spasticity is a common condition in stroke survivors, affecting 17-38% of people. It is a neuromuscular condition usually caused by damage to the portion of the brain or spinal cord that controls voluntary movement, resulting in a change in the balance of signals between the nervous system and the muscles. Spasticity can lead to adverse effects such as overactive reflexes, pressure sores, chronic constipation, urinary tract infections, and contracture.

Spasticity can be treated through oral medications, injected medications, stretching exercises, anti-spasticity orthoses, and in severe cases, surgery. Oral medications, such as muscle relaxers, work by blocking the neurotransmitters that cause muscles to tighten, but they affect all muscles in the body and may have side effects like drowsiness. Injected medications, such as Botox, specifically target the affected muscles and block the chemical that tells them to contract, but may cause side effects such as soreness and trouble swallowing. Stretching exercises are an important part of managing spasticity and can be done with or without assistance, depending on the severity of the condition. Anti-spasticity orthoses, such as dynamic splints, can also be used to relieve pressure on the joints and provide a prolonged muscle stretch. In severe cases where other treatments have failed, surgery may be necessary to release or lengthen tendons or denervate muscles.

Spasticity is a neuromuscular condition usually caused by damage to the portion of the brain or spinal cord that controls voluntary movement

Spasticity is a neuromuscular condition that results from damage to the portion of the brain or spinal cord that controls voluntary movement. It is characterised by a velocity-dependent increase in muscle tone, with exaggerated tendon reflexes, resulting from hyperexcitability of the stretch reflex. This hyperexcitability is caused by an imbalance in the excitatory and inhibitory input to motor neurons, leading to increased muscle activity.

Spasticity is often associated with paralysis, increased tendon reflex activity, and hypertonia (increased muscle tone). It can cause muscle stiffness, spasms, and involuntary contractions, which may be painful and can make walking or performing tasks difficult. In children, spasticity can result in growth problems, painful and deformed joints, and disability. If left untreated, spasticity can lead to permanent joint deformity, pressure sores, and chronic constipation, among other issues.

Spasticity is typically treated with a combination of exercise, physical therapy, medication, or surgery. Treatment aims to improve comfort, mobility, and independence for patients. Oral medications such as baclofen are often used, acting as agonists at GABA receptors to reduce muscle contractions. In more severe cases, surgical treatments such as selective dorsal rhizotomy may be recommended. This procedure involves cutting specific nerve roots to rebalance electrical signals sent to the spinal cord, reducing muscle stiffness while preserving other functions.

Spasticity is a common issue following a stroke, with an estimated 19% of stroke patients developing spasticity within the first three months. It is important to identify and treat spasticity early to prevent negative impacts on recovery and long-term complications.

Spasticity is a velocity-dependent increase in muscle tone in response to passive movement

Spasticity is a form of sustained efferent muscular hyperactivity, dependent on the continuous supraspinal drive to the alpha motor neuron. It is a positive feature of upper motor neuron syndrome, resulting from a loss of inhibition of the lower motor neuron pathways, rather than a loss of connection to the lower motor neuron or other pathways. This results from disordered sensorimotor control of movement due to a lesion of the upper motor neuron, which regulates muscle control.

Spasticity is distinct from hypertonia, which is resistance to passive movement and is not dependent on velocity. Hypertonia can be present with or without spasticity, and vice versa.

Spasticity can lead to adverse effects such as overactive reflexes, pressure sores, chronic constipation, urinary tract infections, and contracture

Spasticity is a common and often disabling problem for stroke patients, affecting 19% of stroke patients within the first three months after the acute event. It can lead to several adverse effects, including overactive reflexes, pressure sores, chronic constipation, urinary tract infections, and contractures.

Overactive reflexes, or hyperreflexia, occur when the body's muscles have an increased or overactive response to stimuli. This can be caused by damage to motor neurons, which transmit signals from the brain to the spinal cord, resulting in conditions such as amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS). Spasticity can also cause overactive reflexes by increasing muscle tone and disrupting sensory-motor control.

Pressure sores, also known as pressure ulcers, are a common complication of spasticity, especially in patients with spinal cord injuries. They are caused by unrelieved pressure, resulting in damage to the underlying tissues, often over bony prominences. Spasticity can make it difficult to relieve pressure and redistribute weight, leading to the development of pressure sores.

Chronic constipation can be caused by various factors, including diet, lifestyle, and underlying medical conditions. Spasticity can contribute to constipation by affecting the nerves that control the digestive tract and disrupting normal bowel movements.

Urinary tract infections (UTIs) are also common in people with spasticity, especially in those with a vagina due to the shorter urethra, which makes it easier for bacteria to enter the urinary tract. Spasticity can increase the risk of UTIs by disrupting normal urinary function and making it difficult to empty the bladder completely.

Contractures are a possible complication of spasticity, characterised by increased muscle tone and reduced joint motion. The increased muscle tone can lead to the formation of contractures, which are challenging to treat once established. Joint mobilisation and spasticity control are essential to prevent contractures and maintain joint flexibility.

Stretching exercises are the simplest and most important step to manage spasticity and recover

Spasticity is a common complication in patients with a stroke, affecting up to 43% of people within a year of the event. It is caused by lesions in the central nervous system and is characterised by stiff and tight muscles. It can make it difficult to perform simple daily tasks and participate in your favourite activities.

Stretching can help enhance neuroplasticity, or the brain's ability to create new pathways to perform functions like managing muscle tone. It can also help you avoid some long-term effects of spasticity, such as contracture, which is when the affected muscles become fixed in a particular position.

Stretching exercises

• Shifting your weight while sitting
• Shoulder blade protraction
• Hand exercises with a therapeutic ball
• Ball pinch exercise
• Wrist and forearm exercise with a water bottle
• Supported reach and grasp
• Side lying hip flexion
• Knee extensions

Other tips to manage spasticity

In addition to stretching, here are some other tips to manage spasticity:

• Modify your home to make it easier to move around and accomplish tasks
• Work with an occupational therapist to learn new ways of performing everyday tasks
• Use mobility aids like canes, walkers, and wheelchairs
• Be as active as possible and keep doing your exercises—the less you move, the worse spasticity may get
• Talk to your doctor, physiotherapist, and occupational therapist about any changes to your muscles

Special orthotics are designed to relieve pressure on the joints, reduce muscle spasms, and provide a prolonged muscle stretch

Orthotics are shoe or heel inserts that are custom-made for the wearer. They can be used to treat foot, leg, or back problems. They can be used to correct foot deformities, help the foot or ankle function better, provide support to the ankle, and reduce the risk of further injuries. They are highly customized shoe or heel inserts made for the wearer's feet.

Orthotics can be used to treat spasticity and its associated complications. They can be used to prevent or compensate for motor dysfunctions, prevent and correct deformities, and treat muscle and joint problems. They can also be used as an effective rehabilitation tool for improving motor function and compensatory abilities.

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