Spasticity Signs and symptoms

The degree of spasticity varies from mild muscle stiffness to severe, painful, and uncontrollable muscle spasms and can show as unusual posturing: carrying the shoulder, arm, wrist, and fingers at an abnormal angle. Severe long term spasticity may lead to contractures of the muscles, a chronic and incurable shortening and tightening. With contracture also comes the possibility of fixed and immobile joints, often at an unusual angle.

Hypertonicity (increased muscle tone):
Hypertonicity is an increased tension of the muscles, meaning the muscle tone is abnormally rigid, hampering proper movement.
Neonatal or congenital hypertonia is usually a result of severe brain damage. Infants experiencing hypertonicity often have joint contractures and general discomfort as well as difficulty feeding. Neonatal hypertonicity is managed with neurodevelopmental techniques in the positioning and handling of the infant.

Clonus:
Clonus is a series of involuntary muscular contractions due to sudden stretching of the muscle. Clonus is a sign of certain neurological conditions, and is particularly associated with upper motor neuron lesions such as in stroke, multiple sclerosis, spinal cord damage and hepatic encephalopathy. Unlike the small, spontaneous twitching known as fasciculations (usually caused by lower motor neuron pathology), clonus causes large motions that are usually initiated by a reflex.
Clonus is most common in the ankles, where it is tested by rapidly flexing the foot upward (dorsiflexion). It can also be tested in the knees by rapidly pushing the patella towards the toes. Only sustained clonus (5 beats or more) is considered abnormal.

Muscle spasms following spinal injury:
When an injury occurs to the spinal cord, the body goes into spinal shock, and this may last several weeks. During this time changes take place to the nerve cells which control muscle activity. Once spinal shock wears off, the natural reflex which is present in everyone reappears.
Spasticity is an exaggeration of the normal reflexes that occur when the body is stimulated in certain ways. In an abled bodied person, a sensory signal is sent to the reflex arch where it travels to the brain via the spinal cord; the brain then assesses the stimulant, and an inhibitory signal is set down the spinal cord canceling the reflex from moving the muscle.

In a person with a spinal cord injury this inhibitory signal is blocked by the structural damage in the cord, and the natural reflex is allowed to continue resulting in a contraction of the muscle. Muscle spasms can occur in a person with a spinal cord injury any time the body is stimulated below the level of injury. This is usually noticeable when a muscle is stretched, or there is a painful stimulant below the level of injury.

Cysts:
According to researchers, a change in a person’s spasticity can be a symptom itself. For example, a cyst or cavity in the spinal cord (sometimes called post-traumatic syringomyelia) could lead to more spasticity. Also, decreasing or disappearing spasticity can also be a sign of a cyst.

Almost anything can trigger spasticity. Some things, however, can make spasticity more of a problem. A bladder infection or kidney infection will often cause spasticity to increase a great deal. A skin breakdown will also increase spasms. In a person who does not perform regular range of motion exercises, muscles and joints become less flexible and almost any minor stimulation can cause severe spasticity. Some spasticity may always be present. The best way to manage or reduce excessive spasms is to perform a daily range of motion exercise program. Avoiding situations such as bladder infections, skin breakdowns, or injuries to the feet and legs will also reduce spasticity. There are three primary medications used to treat spasticity, baclofen, Valium, and Dantrium. All have some side effects and do not completely eliminate spasticity.

 

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