After damage to the brain or spinal cord, sufferers sometimes suffer from movement disorders triggered by increased basic tension in certain muscles. Such “spasticity” can be very limiting – but there are many treatment options!
Our article at a glance:
- How does spasticity manifest itself?
- What are the causes of spasticity?
- What therapy options are there for spasticity?
- Treatment without medication
- Treatment with medication
How does spasticity manifest itself and how does it affect everyday life?
In spasticity, joints or body sections on the muscles are stiffer than normal. The movements are disturbed as a result – and the faster those affected move a joint, the stiffer it becomes (spastic increase in tone). For spasticity after stroke, there are figures on when and how the symptom occurs [1]: Up to 3 months after the stroke, it is the case in 27 percent of all stroke sufferers. More than three months later, the figure is 43 percent.
The picture of spasticity also includes unwanted muscle movements, such as:
- rapid unrhythmic movements (spasms)
- rhythmic movements (clonus)
- unwanted cramped postures (spastic dystonia)
- unwanted slow movements (spastic synergies)
Spasticity often causes pain in affected muscles or joints. Paralysis and premature exhaustion of the muscles can also occur. Typical complications are increasing shortening of muscles and soft tissues up to severe permanent movement and functional limitations of joints (contractures) and considerable skin damage.
Existing spasticity can be exacerbated by restricted movement, pain, emotional tension, inflammation/infections, the urge to defecate or urinate, skin damage, thrombosis or bone fractures. Such factors should be eliminated or treated before initiating any special drug treatment (see below). Necessary examinations for spasticity
In addition to physical examination, there are special diagnostic procedures to detect spasticity. These include a measurement of nerve conductivity, computed tomography, magnetic resonance tomography, blood values and, if necessary, cerebrospinal fluid examination.
Spasticity can also occur in rarer diseases (for example, hereditary spastic paraparesis, HSP). Helpful hints can still give genetic examinations in individual cases. During the examination, one must also consider diseases with slowly increasing nerve cell death such as primary lateral sclerosis or poisoning.What are the causes of spasticity and its effects?
Spasticity often occurs with a delay when brain or spinal cord regions have been damaged, such as:
- Stroke
- Multiple sclerosis
- Traumatic brain injury
- Brain damage after lack of oxygen (hypoxia)
- degenerative brain diseases (such as Alzheimer’s, Parkinson’s, ALS) and spinal cord damage
After such damage, there are changes in the central nervous system [2]. These also change nerves, muscles and soft tissues, changing the mechanical properties and structures in affected muscles and extremities (for example, elastic properties). Spasticity is always caused by several factors. There is no sole cause for them.
After a stroke, people get spasticity more often if they have severe paralysis and sensory disturbances and are significantly limited in coping with everyday life [3]. In addition, it is more likely to get spasticity if the stroke has damaged certain areas of the brain [4]. Help to keep our offer free!
Please donate or become a member – with preferential advice.What therapy options are there for spasticity?
For therapy, it is important how the spasticity is distributed throughout the body. There are different forms here:
- focal spasticity on one or two closely adjacent movement segments (e.g. wrist, foot, toes)
- segmental spasticity of a limb with several movement segments (e.g. pointed foot with spastic knee and hip flexion posture)
- both arms or legs (paraspasticity)
- both arms and both legs (tetraspasticity)
Treatment of spasticity without medication
For treatment, there are therapies with and without drugs. Non-drug treatments include:
- motor exercises without the use of equipment, stretching of affected muscles and joints
- device-assisted therapy including walking and movement robots, with the help of which arms and legs are mobilized (examples), as well as treadmill therapy
- Rails, bandages and split pins (air rails or sleeves for stretching and bearing)
- physical measures such as cold/heat, massages, shock wave therapy and electrostimulation
Systematic arm-base training [5], frequent repetitions and combination with muscular electrostimulation [6] have beneficial effects on spasticity. Here, the so-called movement induction therapy should be mentioned as a procedure.
Passive muscle stretching is particularly important in addition to the selected standard therapy [7]. Device-assisted combination therapies with electrostimulation can even prevent spastically increased muscle tone while simultaneously improving motor function [8].
For the therapy of stability, gait, climbing stairs or the arm-hand function, promising improvements in spasticity can be seen through the use of robots [9]. They enable almost natural movement sequences of the extremities in a high number of repetitions.
Splints, sapwoods, casts and orthoses compensate for paralysis and have beneficial effects on muscle tension and muscle length. This avoids permanent movement and functional restrictions of joints (contractures).
For the legs, the straightening of those affected is the best form of mobilization. By creating casts, a limited range of motion can be gradually extended again. Here, the combination with a local botulinum toxin treatment makes sense and is recommended (see below).
Electrostimulation activates nerves and muscle fibers with small currents (transcutaneous electrical nerve stimulation, TENS) via electrodes glued to the skin. Here there are positive effects on spasticity and range of motion (ROM) [10]. Functional electrical stimulation (FES) for movements that are performed wholly or partially by the patient himself (e.g. grasping and handling, walking) can also have a spasticity-reducing effect in addition to improving motor functions. Beneficial effects on spasticity have also been described by surface electrostimulation of the spinal cord or nerve roots or by electroacupuncture [11].
Repetitive magnetic stimulation and extracorporeal shock wave therapy
A spastic increase in tone can be treated with targeted magnetic field stimuli to stimulate selected nerves, nerve roots or brain areas (peripheral repetitive magnetic stimulation, prMS; repetitive transcranial magnetic stimulation, rTMS). Shock wave therapy can reduce a spastically increased muscle tone for weeks with an accompanying expansion of the range of motion (extracorporeal shock wave therapy, ESTW) [12]. However, limited data do not yet allow a treatment clear recommendation for routine clinical use for these procedures.Treatment of spinal cord injury
For people with spinal cord injury, the treatment priorities and achievable treatment goals depend on the amount of spinal cord damage and the extent of the paralysis. An increased muscle tone in the legs can even lead to paralysis of both legs, to the fact that sufferers can still walk, albeit very uncertainly. However, strong spastic increases in tone, shooting extensor or flexion spasms, strong muscle twitches (spasticity with involuntary rhythmic muscle twitches) and unwanted co-movements of non-activated muscle groups are problematic. Regular exercise and device-assisted movements help to reduce these disturbing phenomena of damage to the brain/spinal cord and especially spastic muscle tone. Training with whole-body vibration over a few days [13] and robot-assisted gait therapy using exoskeletons can have a positive effect on the spastic increase in tone in the legs [14]. Treatment of spasticity with medication