Spasticity is one of the features of upper motor neuron (UMN) syndrome. UMN syndrome is caused by damage to one (or more) areas of the central nervous system (CNS) involved in controlling voluntary movement. UMN syndrome can be divided into two broad groups – negative phenomena and positive phenomena.
Spasticity patients are usually oriented to multiple healthcare settings, which differ significantly in their treatment aims. In stroke or intensive care units and other hospital wards the main focus is the patient’s survival. After this acute phase the focus shifts towards the rehabilitation and general care of the patient. If the patient is sent to a nursing home, however, only basic care is generally provided.
In everyday life, persons living with spasticity may experience physical symptoms (e.g., pain, contractures, pressure sores), decreased functional abilities, difficulties with mobility, hygiene, care and decreased quality of life. They can also be prone to developing secondary conditions such as infections and psychological disorders, especially anxiety, loss of self-esteem and depression.
The treatment of adult with spasticity should be provided by a multidisciplinary team employing a shared-care approach. A variety of treatment options is available and clinical experience has shown that a multi-modal approach has many benefits.
Spasticity is one of several clinical features/motor behaviors that may result following damage to the part of the brain or spinal cord involved in controlling voluntary movement. Collectively, these features are known as the upper motor neuron (UMN) syndrome. Spasticity is associated with a pathologically increased muscle tone. This creates stiffness and resistance to passive movement (the word ‘spasm’ originates from the Greek word, ‘spasmos’, which means to drag or pull). This change in muscle tone may increase the disability related to the disease at the origin of spasticity.
Muscle tone is a state of tension that is maintained continuously – minimally even when relaxed – and which increases in resistance to passive stretch. It helps to maintain posture and decreases during sleep. The stretch reflex is a muscle contraction in response to stretching within the muscle. This reflex, by definition extremely fast exists to allow the muscle to adapt to any kind of muscular tone, to avoid over-stretching , e.g. when need to adapt to a brutal change of the ground.
In spasticity, the muscle tone is abnormally increased (muscle hypertonia), and reflexes such as the stretch reflex may persist for too long and may be too strong (hyperactive reflexes). These phenomena cause an increased resistance to passive movement (e.g., if someone else tries to move the extremities of the person affected) characterized in the following ways:
it increases with increasing speed of stretch and varies with the direction of joint movement and/or
it increases above a patient-specific threshold speed or joint angle
The slower the speed and the smaller the angle when spasticity appears, the more severe it is.
Overall, spasticity affects about 500,000 people in the United States and more than 12 million people throughout the world.
38% of stroke survivors experience post-stroke spasticity within one year after a first stroke, while the overall prevalence of post-stroke spasticity is approximately 0.2% (taken from the WHO MONICA project)
85% of patients with multiple sclerosis have some form of spasticity and 34% have spasticity that affects their daily living
It is estimated that Cerebral Palsy (CP) affects 2 to 4 out of every 1,000 children between 3 and 10 years of age worldwide
62% of patients with spinal cord injury are reported to have spasticity
It is estimated that currently only 5 to 10% of the spasticity patients that would benefit from toxin injections are treated with botulinum neurotoxin.
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