Spasticity And Stroke: Understanding The Connection

Spasticity is a common complication following a stroke, causing stiff or rigid muscles. It occurs when a muscle involuntarily contracts during movement and is commonly observed in the elbow, wrist and ankle.

Spasticity can make muscles feel stiff and tight, and they may resist movement. It can also cause muscle spasms, and in the arm, a clenched fist or fingers, a bent arm held against the chest, and in the leg, tightness in the knees and a pointed or dropped foot.

Spasticity can cause contracture, where muscles become so tight that joints have a limited range of movement and may become fixed in one position. This usually happens in the hands, elbows, knees or ankles.

Spasticity can be treated with physiotherapy and occupational therapy, which aim to improve movement and control and prevent other problems such as pain. Treatments can include exercises to lengthen and strengthen muscles, casts to help stretch and lengthen tight muscles, taping to improve movement, and electrical stimulation. For severe spasticity, doctors may prescribe medication such as botulinum toxin A or muscle relaxant tablets.

Spasticity is a common complication of stroke, causing stiff or rigid muscles

Spasticity is a result of messages between the brain and muscles being interrupted by a stroke. It can cause muscles to feel stiff and tight, and they may resist movement. For example, a person may try to move their arm, but it doesn't move as much as expected, or it may jerk back towards the body in response. Spasticity in the legs can make it difficult to walk and increase the risk of falling, while spasticity in the arms can affect a person's ability to open their hand or reach for something.

There are various treatments for spasticity, including physiotherapy, occupational therapy, and in severe cases, medication. Physiotherapy and occupational therapy aim to improve movement and control and prevent other problems such as pain. Treatments may include exercises to lengthen and strengthen muscles, casts to help stretch tight muscles, taping to improve movement, and electrical stimulation. For severe muscle spasticity, a doctor may prescribe medication such as botulinum toxin A or muscle relaxant tablets.

Spasticity can lead to contracture, a permanent loss of joint motion

Spasticity is a common complication after a stroke, causing stiff or rigid muscles. It occurs when a muscle involuntarily contracts during movement and often affects the elbow, wrist, and ankle. Spasticity can lead to contracture, a permanent loss of joint motion. This happens when the increased muscle tone associated with spasticity results in a reduced range of motion in the joints, causing the tendons and soft tissue surrounding them to tighten. This tightening makes it much more difficult to stretch the muscle, and if left untreated, can result in frozen joints in the arms and legs. This condition is called contracture.

Contractures are challenging to treat, and prevention is emphasized as a critical aspect of managing spasticity. Various treatments are available for spasticity, including physical exercise, oral medications, botulinum toxin injections, and surgical procedures. These treatments aim to reduce muscle spasticity and prevent the development of contractures. It is important to consult with healthcare professionals to determine the most suitable treatment options for managing spasticity and preventing contractures.

Spasticity can be measured using scales such as the Ashworth Scale, Modified Ashworth Scale, and Tardieu Scale

Spasticity is a common complication of a stroke, affecting 19% to 92% of survivors. It is characterised by stiff or rigid muscles, which can cause significant difficulty with daily tasks. Spasticity can be measured using scales such as the Ashworth Scale, Modified Ashworth Scale, and Tardieu Scale.

The Ashworth Scale is a simple clinical test of resistance to passive stretch, which is limited by poor inter-rater reliability. The Modified Ashworth Scale is a modified version of the Ashworth Scale, which has been shown to have adequate reliability for determining lower-extremity spasticity in patients with spinal cord injuries.

The Tardieu Scale was developed in 1954 and has since been modified. It quantifies muscle tone at specified velocities and has been suggested to be superior to the Ashworth Scale for the assessment of neural versus peripheral contributions of spasticity. The Modified Tardieu Scale (MTS) was developed in 1999 and standardises the conditions of limb placement and the speeds of stretch. The MTS has been shown to have excellent inter-rater and test-retest reliability for the measurement of spasticity.

Botulinum toxin injections are a common treatment for spasticity, reducing muscle tone and improving function

Botulinum toxin injections are considered the first-line treatment for focal spasticity. They are safe and effective, reducing muscle tone and increasing range of motion. The benefits of botulinum toxin injections include:

• Significantly improved gait pattern
• Improvement in positioning and range of motion
• Decreased pain in stiff muscles
• Reduction of spasticity and greater ease in stretching
• Improved tolerance of braces
• Possible delay in surgery until the patient is older
• Improved independent use of the upper extremities for activities of daily living

Botulinum toxin injections do not always lead to functional improvement, and the effects last for around three months. However, they can be combined with other treatments, such as physical therapy and electrical stimulation, to enhance their effectiveness.

Intrathecal baclofen therapy is another treatment option for severe spasticity, delivering medication directly to the spinal cord

Spasticity is a common post-stroke condition that causes stiff or rigid muscles. It occurs when a muscle involuntarily contracts when you move and commonly affects the elbow, wrist and ankle. About 25% to 43% of survivors will have spasticity in the first year after their stroke.

Intrathecal baclofen therapy (ITB) is a treatment option for severe spasticity, delivering medication directly to the spinal cord. It is a surgical procedure that involves implanting a small pump under the skin of the abdomen. The pump is connected to a thin, flexible tube called a catheter, which delivers the medication to the fluid in the spinal canal. The pump contains a battery, a reservoir for the medication and a microprocessor.

ITB is effective in managing post-stroke spastic hypertonia and can enhance functional recovery of gait and upper limb use, and improve quality of life. It is recommended for patients who do not respond well to other treatments or experience adverse reactions. The benefits of ITB include effective management of spasticity, continuous medication delivery, fewer side effects than oral baclofen, and the option to program different doses at different times.

However, ITB is not the most commonly used treatment for spasticity, and surgery is required for its implantation. Potential side effects and complications include infection at the surgical site, leakage of spinal fluid, and increased weakness. There is also a risk of baclofen withdrawal or overdose if the pump runs out of medication or there is a problem with the pump or catheter.

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