Spasticity

Spasticity is a progressive neuromuscular symptom caused by either damage to nerves in your brain or spinal cord or by underlying neuromuscular disorders. One of the disorders it’s most associated with is cerebral palsy.

What is spasticity?

When you have spasticity, your muscles are stiff and they spasm when you try to move. It makes your movements jerky and uncontrollable, and your muscles will spasm more when you try to move faster.

Is spasticity the same as hypertonia?

Hypertonia is a general term that refers to having high muscle tone. Hypertonic muscles always have extra tension in them even when they’re not being used.

Spasticity is one type of hypertonia. With hypertonia that doesn’t include spasticity, your difficulty with movements won’t be affected by how quickly you’re trying to move. When hypertonia includes spasticity, speed always matters – the more quickly you try to move, the more your muscles spasm and resist moving.

Is hypertonia a disability?

Hypertonia can cause disability if it becomes severe enough. If hypertonia with or without spasticity causes difficulties performing everyday tasks such as bathing, cooking, eating or walking, you may need home health care or to live in an assisted living setting.

Symptoms of spasticity

Spasticity may be painful and intense or it may be mild spasms with little pain. Some of the movements that happen with spasticity are:

• Abnormal postures
• Clonus (series of fast involuntary muscle contractions)
• Involuntary crossing of legs (also known as scissoring)
• Muscle spasms

Some effects of spasticity are results from chronic movements. They include:

• Muscle fatigue
• Muscle, joint or bone deformities
• Pain or tightness in joints
• Sleep disruption because of pain from muscle spasms or tightness

Complications of spasticity

When spasticity has lasted a long time, it may lead to some of these complications:

• Chronic constipation
• Contracture (permanent contraction of muscles and tendons)
• Fever or other systemic illnesses
• Joints that can’t move
• Pressure sores (damage to skin because of long-term pressure)
• Urinary tract infections (UTI)

Possible causes of spasticity

Spasticity is usually caused by damage to nerves within the brain or spinal cord that control muscle movement and stretching. Spasticity may also be related to underlying conditions such as:

• Adrenoleukodystrophy (ALD)
• Amyotrophic lateral sclerosis (ALS)
• Brain or head injury
• Cerebral palsy
• Hereditary spastic paraplegias
• Krabbe disease (also known as globoid cell leukodystrophy)
• Multiple sclerosis
• Phenylketonuria (PKU)
• Spinal cord injury
• Stroke

Diagnosis of the cause of spasticity

Since spasticity may be the result of a variety of underlying conditions, your doctor will work with a multidisciplinary team that may include some of these specialists:

• Neurologist
• Neurosurgeon
• Occupational therapist
• Orthopedic surgeon
• Physiatrist (a rehabilitation specialist)
• Physical therapist
• Speech and language pathologist

Your Aurora Health Care team will need to diagnose the cause of your spasticity by systematically ruling out disorders that don’t apply to you. Your muscle tone, posture and walking (gait) will be evaluated, and they’ll move your joints manually to see how they function.

They’ll do various lab tests on blood and urine and imaging tests to evaluate your bones, joints and muscles. You may need to have a spinal tap to gather a sample of cerebrospinal fluid for testing.

Spasticity treatment options

There’s no cure for spasticity as a symptom, so you’ll receive treatment to ease spasticity symptoms or to treat any underlying disorders.

Nonsurgical spasticity treatments

Nonsurgical treatments that can help spasticity include:

• Assistive devices to help you move around and perform daily tasks more safely and efficiently
• Casts or braces to provide sustained muscle stretching
• Medications to help with sleep, pain or everyday functioning
• Occupational therapy for smaller muscle groups to manage daily activities like bathing and cooking
• Physical therapy for larger muscle groups to manage standing and walking
• Speech therapy to help when spasticity affects your speech or ability to eat and swallow

Another potential treatment for spasticity is Botox injections. Such injections are applied carefully to specific parts of muscles to stop the muscles from contracting involuntarily.

Nonsurgical treatments are usually used together to improve quality of life and ease symptoms.

Surgical spasticity treatments

In severe cases of spasticity, surgical treatments may be recommended.

One surgical option is implanting a pump to deliver the medication baclofen directly through a catheter into the spinal fluid. Delivering the medication directly reduces pain and spasticity in the arms and legs with fewer side effects than taking it orally.

A surgery called Selective Dorsal Rhizotomy (SDR) is used to cut carefully selected nerve roots to reduce spasticity in the legs. SDR is used for people with cerebral palsy to decrease muscle stiffness without affecting other muscle functions.

Sometimes orthopedic surgery is performed to lengthen tendons or transfer tendons to improve problems with long-term contractions of muscles or tendons or deformities of bones, joints or muscles.