Spasticity is a clinical sign that occurs in numerous neurological conditions, such as stroke, multiple sclerosis, hypoxic brain damage, traumatic brain injury, spinal cord injury, tumors and degenerative diseases. It is a disorder that causes a loss of functionality and autonomy in the individual, affecting quality of life.
Clinical variability of spasticity
This disorder appears as a result of a lesion in the central nervous system and is part of the so-called upper motor neuron syndrome, in which negative symptoms (weakness, fatigue or decreased dexterity) or positive symptoms (clonia, Babinski’s sign, spasticity, flexor or extensor spasms, dyssynergic contraction patterns or dystonia) are observed.
Depending on the etiology, spasticity can be divided into:
- Supraspinal: such as stroke or cerebral palsy.
- Spinal and mixed.
- With spinal and supraspinal involvement: such as multiple sclerosis or amyotrophic lateral sclerosis.
Depending on the localization it can be classified into:
- Focal spasticity: affects an isolated area of the body.
- Multifocal spasticity: affects multiple isolated or non-contiguous areas of the body.
- Regional and general spasticity: affects a large continuous region or multiple large areas of the body.
What are the functional implications?
Mild spasticity may be beneficial because it prevents bone decalcification, promotes standing and may provide cardiovascular benefit by decreasing the risk of deep vein thrombosis. However, on other occasions it has serious physical, emotional and social consequences: daily life becomes difficult, joint stiffness, contractures, pain, abnormal postures, limitation of movement, etc.
Treatment of spasticity
The treatment of spasticity is multidisciplinary and involves different specialists: physicians, physiotherapists, occupational therapists, orthopedic technicians and nurses.
Before designing a treatment for spasticity, its impact on overall mobility should be assessed. Whether it causes pain or reduces the degree of autonomy and participation in social life should be assessed. Not all spasticity should be treated, as in some cases, it may be beneficial.
The most commonly used treatments are the following:
- Physiotherapy: To reduce excessive muscle tone, give the patient a sense of proper position and facilitate movement, and avoid joint limitations.
- Transcutaneous electrical stimulation: Generally used to reduce pain, but can reduce spasticity and improve static balance and gait speed in stroke patients.
- Use of orthoses: Splints and orthoses are used to maintain the displaced or mobile body segment in a certain position to prevent injury, correct deformities or assist in motor activities.
- Chemodenervation and neurolysis therapies: Focal treatment by infiltration with botulinum toxin is useful when spasticity affects only a few muscle groups.
- Pharmacological therapy: Many orally administered antispastic drugs are available.
- Surgical treatment: The fundamental surgical techniques for the treatment of spasticity are tendon lengthening or transposition of tendons are surgical techniques.