Spasticity

What is spasticity?

Spasticity is a condition that causes disruption in the movement patterns of certain muscles. It causes these muscles to contract at the same time when you are moving or resting.

Spasticity affects movement and can affect the way you mobilise or walk. It can affect people differently, varying in severity from mild muscle tightness to severe and uncontrollable spasms and stiffness. Treatment options for spasticity include physical therapy, medication and botulinum toxin injections.

Our muscles are normally able to contract and relax independently of one another. If the nerves in our central nervous system become damaged, this pattern can become disrupted, and many muscles all contract at the same time. This makes voluntary movement difficult.

Spasticity can cause:

• Muscle spasms (these are quick, involuntary contractions of muscles).
• Pain/discomfort.
• Abnormal posture.
• Difficulty with everyday tasks.
• Fast and involuntary contractions that may feel like a tremor (called clonus)
• Increased muscle tone (called hypertonia).
• Involuntary muscle spasms or movements like leg crossing or knee bending.
• Muscle, joint and/or bone deformities.
• Permanent contraction of muscles due to lasting, severe lasting stiffness (called contracture).
• Muscle stiffness causing pain and sleep disruption.

Is spasticity the same as rigidity?

Both muscle spasticity and muscle rigidity cause a state of high muscle tone, but they are different. Rigidity is usually associated with damage to the basal ganglia, which is a group of structures linked to your thalamus and involved with the coordination of your movement. Rigidity can affect all muscles around a joint equally. Rigidity causes a constant increase in muscle tone, while spasticity causes a rapid movement and stronger involuntary contraction of the affected muscles.

What causes spasticity?

Spasticity is often caused by damaged central nervous system pathways, that control movement and stretch reflexes, within your brain or spinal cord. Several conditions can cause spasticity, including:

• Multiple sclerosis
• Stroke
• Spinal cord injury
• Cerebral palsy
• Amyotrophic lateral sclerosis (ALS)
• Traumatic Brain/head injury
• Encephalitis or Myelitis
• Hereditary spastic paraplegias

How is spasticity treated?

There are several ways to treat spasticity, and it is usually treated in more than one way at a time. Treatments can help reduce symptoms and improve your quality of life.

Nonsurgical spasticity treatments include:

• Physical therapy
• Occupational therapy
• Speech therapy
• Oral medications
• Casting or bracing
• Botulinum toxin injections
• Cryoneurolysis

In severe cases, surgical treatment may be recommended, such as:

• Orthopaedic surgery: Addresses problems caused by spasticity in muscles, connective tissues and bones, such as deformities and contractures.
• Intrathecal baclofen therapy: This surgery involves placing a pump in the abdomen which releases medication steadily into the spinal fluid.
• Selective dorsal rhizotomy: Aims to rebalance the electrical signals sent to the spinal cord. Nerve roots are cut surgically when severe spasticity is affecting the legs.

Spasticity treatment involves a multidisciplinary team of specialists, which may include:

• Physical therapists
• Neurologists
• Rehabilitation specialists
• Occupational therapists
• Speech and language therapists
• Orthopaedic surgeons
• Neurosurgeons.