Spasticity – Symptoms and Treatments
You’ve been noticing that your child’s movements are different than your first-born, and that she keeps her arms straight rather than bending them. Sometimes she seems stiffer than at other times. Her stiffness seems to be worse when she is tired or sick. What is it? Often times, these are signs of “Spasticity,” and are found in conditions where the brain and/or spinal cord are damaged or fail to develop normally. These conditions include cerebral palsy, multiple sclerosis, spinal cord injury and acquired brain injury, including stroke.
Spasticity is a form of muscular hypertonicity (increased tone or stiffness of a muscle). It is often associated with weakness and increased deep tendon reflexes. Spasticity is characterized by movements that require great effort and lack of normal coordination. It is most commonly seen in children with cerebral palsy and is often the cause for referral to physical therapy intervention.
Spasticity can cause problems moving the body or parts of the body, making activities of daily living more difficult. Unrelenting spasticity can cause deformities of the bones that the spastic muscles are attached to or the joints that they cross. It can also limit the degree of movement a joint can bend or straighten.
The cause of cerebral palsy is most usually due to neonatal asphyxia, causing a defect in the upper motor neurons of the central nervous system. This can cause the muscles to become overactive. In effect, they cannot be “turned off”; they are always in a state of alertness. This can make the arms and legs difficult to move or be moved. Typically, one group of muscles will be more active than another, causing more flexion (bending) or extension (straightening). Severe spasticity results when both sets of muscles are active at the same time, making the body part nearly rigid.
Good management of spasticity can reduce the need for surgery to release tight muscles and tendons, allow better care and ease of dressing, allow better speech and feeding skills, and reduce pain associated with the stiffness of tight musculature. Intensive Physical Therapy can be helpful in educating families in the use of exercises and positioning that can reduce the effects of spasticity on the body and make movement easier with less effort. Exercises that keep the muscles stretched out allow greater range of movement of the joints. Strengthening the muscles that act against the spastic group of muscles is also effective in mild to moderate spasticity.
For more severe cases of spasticity, treatment may include use of oral medications, Baclofen pump, botulinum toxin injected into the muscle belly of the affected muscle, alcohol blocks and use of orthotics (braces) to maintain and support joint integrity. A surgical intervention called selective dorsal rhizotomy involves cutting selected sensory nerves in the spinal cord to decrease spasticity. Serial casting can also be used. No single type of intervention is best for all children with spasticity; many use more than one but all should have some type of exercise regimen to help manage the effects of spasticity.
This article was written for Oakland County Moms by Carol Goubeaux, PT/Euro-Peds National Center for Intensive Pediatric PT