FAQ

Below you will find the most frequently asked questions (FAQs). We will be udpating this section periodically.


Why did I develop spasticity?

Spasticity happens when there is damage to the area of your brain that controls your muscles. If you have spasticity you will have increased muscle tone. Muscle tone is the resistance or tension in your muscles, and it is what enables us to hold our bodies in a particular position. An increased muscle tone can make it difficult to move your limbs.

source: Stroke Association (2012) Pain after stroke

What is spasticity?

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.

What’s the best way to explain my condition to family members so they understand?

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:

  1. it increases with increasing speed of stretch and varies with the direction of joint movement and/or
  2. 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.

How is spasticity diagnosed and who do you get the diagnosis from?

Diagnosis of spasticity is mainly based on clinical evaluation that should include:

  • Clinical history
  • Physical examination
  • evaluation of stretch reflexes (e.g., deep tendon reflexes, involuntary muscle contractions provoked by stretching the muscle with a tap on the tendon that connects the muscle to a bone)
  • passive and active motion
  • Function, e.g., toileting, eating, sleeping, dressing, sitting, standing, and walking

A proper assessment of the individual’s clinical and neurological status is critical in developing an effective treatment plan with achievable goals.

Spasticity is diagnosed if the patient shows an increased resistance to passive movements that increases with speed and typical positioning of the limbs, due to increased muscle tone. The diagnosis is not complicated for rehabilitation specialists but unfortunately a lot of other specialists/HCP are not trained and thus don’t recognized the symptoms or when they do so, don’t see the potential benefit of an adapted treatment.

Why does it take so long to identify spasticity in stroke patients?

Spasticity is diagnosed if the patient shows an increased resistance to passive movements that increases with speed and typical positioning of the limbs, due to increased muscle tone. The diagnosis is not complicated for rehabilitation specialists but unfortunately a lot of other specialists/HCP are not trained and thus don’t recognized the symptoms or when they do so, don’t see the potential benefit of an adapted treatment.

There is a pain at the back of my head since developing spasticity, is the pain caused by spasticity?

Yes, that is possible. Depending on the localization of the spasticity, the surrounding muscle groups are trying to give the body a balance and this can lead to tensions – up to the head.

I can feel my wrists getting stiff, how do I know if I am developing spasticity?

Diagnosis of spasticity is mainly based on clinical evaluation that should include:

  • Clinical history
  • Physical examination
  • evaluation of stretch reflexes (e.g., deep tendon reflexes, involuntary muscle contractions provoked by stretching the muscle with a tap on the tendon that connects the muscle to a bone)
  • passive and active motion
  • Function, e.g., toileting, eating, sleeping, dressing, sitting, standing, and walking

A proper assessment of the individual’s clinical and neurological status is critical in developing an effective treatment plan with achievable goals.

Spasticity is diagnosed if the patient shows an increased resistance to passive movements that increases with speed and typical positioning of the limbs, due to increased muscle tone. The diagnosis is not complicated for rehabilitation specialists but unfortunately a lot of other specialists/HCP are not trained and thus don’t recognized the symptoms or when they do so, don’t see the potential benefit of an adapted treatment.

The features of spasticity should be assessed individually for each patient, with the focus on three main areas: The clinical pattern of motor function, the patient’s ability to control his or her muscles, and how muscle stiffness and any contractures worsen the functional problems. The clinical pattern is of particular interest as it helps to identify the muscles affected by spasticity and thus to determine an appropriate treatment. Some physicians use diagnostic nerve blocks (local transient anesthesia of nerve(s)) to evaluate the involvement of muscles in a specific spastic pattern), or electromyography (EMG, evaluating activity of muscles while the patient performs a movement or a task via external electrodes).

What should I do if I think I am developing spasticity? 

Post-stroke spasticity is usually diagnosed and treated at rehabilitation centers, where many experts, such as, rehabilitation specialists, occupational therapists, physical therapists, speech therapists, psychologists, social workers, nurses…, work together to provide patients with different treatment options.

What  forms of spasticity are prevalent in stroke survivors?

Spasticity can occur in the upper and lower limbs. The body region and the extent to which it is affected depend on the area of the brain or spinal cord that has been damaged.

  • In spastic hemiplegia, the muscles of one side of the body are affected. Generally, injury to the left side of the brain will cause symptoms in the right side of the body, and vice versa. Hemiparesis is weakness on one side of the body. It is less severe than hemiplegia. Thus, the patient can move the impaired side of their body, but with reduced muscular strength.
  • In patients with spastic diplegia, most often the lower limbs are affected, called then paraplegia. In that case, it is mainly related to a lesion of the spinal cord. Rarely diplegia concerns the 2 upper limbs.
  • All four limbs are affected in patients with spastic quadriplegia. These patients are the least likely to be able to walk. This is mainly related to lesion of the spinal cord.

After my stroke two of my fingers are stiff, how do I know if this is spasticity?

Diagnosis of spasticity is mainly based on clinical evaluation that should include:

  • Clinical history
  • Physical examination
  • evaluation of stretch reflexes (e.g., deep tendon reflexes, involuntary muscle contractions provoked by stretching the muscle with a tap on the tendon that connects the muscle to a bone)
  • passive and active motion
  • Function, e.g., toileting, eating, sleeping, dressing, sitting, standing, and walking

A proper assessment of the individual’s clinical and neurological status is critical in developing an effective treatment plan with achievable goals.

Spasticity is diagnosed if the patient shows an increased resistance to passive movements that increases with speed and typical positioning of the limbs, due to increased muscle tone. The diagnosis is not complicated for rehabilitation specialists but unfortunately a lot of other specialists/HCP are not trained and thus don’t recognized the symptoms or when they do so, don’t see the potential benefit of an adapted treatment.

The features of spasticity should be assessed individually for each patient, with the focus on three main areas: The clinical pattern of motor function, the patient’s ability to control his or her muscles, and how muscle stiffness and any contractures worsen the functional problems. The clinical pattern is of particular interest as it helps to identify the muscles affected by spasticity and thus to determine an appropriate treatment. Some physicians use diagnostic nerve blocks (local transient anesthesia of nerve(s)) to evaluate the involvement of muscles in a specific spastic pattern), or electromyography (EMG, evaluating activity of muscles while the patient performs a movement or a task via external electrodes).

When is it advantageous to use physiotherapy to treat spasticity?

Physiotherapy is the base of the treatment of spasticity. It keeps the affected muscles and joints mobile and flexible. Which of the physiotherapeutic exercises are suitable for each patient depends on the respective disease pattern.

Are treatments with baclofen tablets effective in all cases? If not, in which cases are they ineffective?

Sometimes, in case of chronic, very strong and extremely painful spasms, an oral dose of Baclofen is not sufficient. As an alternative, these patients have been given the intrathecal application of Baclofen through an implanted pump. This is a continuous therapy; however, in case of acute pains, a single injection of the active ingredient, into the spinal cord, is also possible.

What makes me eligible for treatment for spasticity?

If you have had spasticity after a stroke or an accident or due to a hereditary reason, than you are eligible to get treatment. Please consult an experienced health professional to assess which spasticity treatment is the most suitable for you.

Will my spasticity return once it has been treated?

This depends on many factors, such as the cause and the extent of the injury to the brain and spinal cord. Spasticity requires regular treatment until it reaches a point where further treatment is no longer required.

Which treatment option for spasticity is more effective?

A team of specialists will decide on the best treatment for you and this will vary from person to person. Treatment options can include physiotherapy, medication and botulinum toxin injections. Please consult an experienced health professional to assess which spasticity treatment is the most suitable for you.

I still experience spasticity after physiotherapy. Why didn’t this treatment work?

Spasticity usually responds well to multiple methods of treatment rather than just one. Physiotherapy usually works better in association with other treatments such as medications or botulinum toxin injections. Physiotherapy alone may reduce spasticity, but this is not the case for all stroke survivors.

Is amputating a limb ever an option to treat spasticity?

This is very unlikely and is only used when no other surgical option is available.

When spasticity is more prevalent in the feet, is it advisable to get surgery?

If spasticity affects only one or two specific parts of your body, you may be given botulinum toxin as an injection. The benefit of botulinum toxin has been established for various muscles affected by spasticity. The effects of botulinum toxin usually last for about three months. Botulinum toxin treatment should be given with further rehabilitation such as physiotherapy, or other treatments like splinting or casting. You should also have an assessment three to four months after the treatment.

source: Stroke Association (2012) Pain after stroke

Are treatments with botulinum toxin injections effective in all cases? If not in what cases are they ineffective?

If spasticity affects only one or two specific parts of your body, you may be given botulinum toxin as an injection. The benefit of botulinum toxin has been established for various muscles affected by spasticity. The effects of botulinum toxin usually last for about three months. Botulinum toxin treatment should be given with further rehabilitation such as physiotherapy, or other treatments like splinting or casting. You should also have an assessment three to four months after the treatment.

source: Stroke Association (2012) Pain after stroke

What is the best treatment for stroke survivors with spasticity?

When does the spasticity appear during a stroke?

38% of stroke survivors experience post-stroke spasticity within one year after a first stroke.

How is spasticity treated?

Is there any medication that will ease my spasticity?

How can you stop ongoing spasms?

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.  In most cases, a combination of various types of treatment is required to achieve the specific goals of treatment for a particular patient.

A rehabilitation plan must be tailored to individual patient needs, and is likely to involve medical intervention (e.g., botulinum toxin, pain medication), as well as multiple additional therapies – for example physical, occupational and psychological approaches. Together, these therapies enable optimal management of functional problems such as impaired mobility, strength, balance, and endurance, amongst other spasticity-related issues.

The primary aim of treatment is to facilitate life for people with spasticity and for their caregivers, thus improving their quality of life. Therefore, improvement in function is a key long-term factor in spasticity management. Consequently, the development of realistic and clinically relevant goals for each individual patient is the key for a successful treatment. These goals should  be defined  and  followed  up in collaboration with other members  of the  spasticity management team that  may include a specialist for physical medicine and rehabilitation, a neurologist, a physiatrist, a physiotherapist, an occupational therapist, a neurosurgeon, and an orthotist  (specialist concerned with the design,  manufacture and application  of orthoses).

The importance of adapting the treatment to patients’ symptoms and especially to patients’ needs throughout the course of treatment is crucial, with expectations revisited and redefined if necessary at regular intervals.

What is the likelihood of developing post-stroke spasticity if I’ve had a stroke?

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)

What medications can help? 

When is it advantageous to use botulinum toxin to treat spasticity?

Botulinum toxin type A (BoNT/A) is recommended as a first-line therapy in national and international guidelines as part of an integrated treatment approach for post-stroke spasticity.

Botulinum toxin creates a ‘window of opportunity’ for improving motor and activity performance3 and should always be followed by physical therapy.

Which are the advantages of using physiotherapy to treat spasticity? 

Physical therapy is the mainstay of treatment for spasticity, and is designed to reduce muscle tone, maintain or improve range of motion and mobility, increase strength and coordination, and improve care and comfort.

What are the advantages and the disadvantages of having surgery to treat spasticity ?

When not controllable by physical therapy, oral or intrathecal medications and/or botulinum toxin injections, spasticity symptoms can be treated with selective ablative procedures. In most cases, complementary neurosurgical and functional orthopedic approaches are used.

With surgical interventions, muscles can be denervated or tendons and muscles can be released, lengthened, or transferred to relieve the symptoms of spasticity. In practice, only 5% of spasticity patients undergo a surgical intervention.

By orthopedic surgery, muscles can be denervated, and tendons and muscles can be released, lengthened, or transferred. In order to release contractures, the contracted tendon is partially or completely split surgically and then the joint is repositioned at a more normal angle.  A cast stabilizes the joint over a period of several weeks while the tendon regrows.  After removing the cast, physical therapy is necessary to strengthen the muscles and improve the patient’s range of motion.

Surgical intervention that is used for the treatment of spasticity is called functional or selective dorsal rhizotomy (SDR). In this procedure, the neurosurgeon  cuts nerve roots (rhizotomy) – the nerve fibers lying just outside  the back bone  (spinal column) that  send sensory messages from the muscles to the spinal cord. ‘Selective’  indicates that  only certain  nerve roots are cut, and ‘dorsal’ refers to the target  nerves that  are located  at the back of the spinal cord (the upper  surface  when  a person  is lying on his or her stomach).

What causes spasticity?

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.

What causes the muscles to contract?

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.

Negative phenomena refer to what is lost, such as fine motor skills, strength, and motor control.

Positive phenomena are characterized by an abundance of muscle hyperactivity, such as spasticity, hypereflexia (increased stretch reflexes), clonus (uncontrollable movement of a body limb, especially the ankle), co-contractions (involuntary contractions of a limb or a part of the limb while the patient is actively moving another part (e.g., lower limb) (e.g., adduction of the shoulder while walking), or muscles spasms.

How soon after a stroke does spasticity develop?

38% of stroke survivors experience post-stroke spasticity within one year after a first stroke.

Why & how does spasticity develop?

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.


How Karl’s life is influenced by spasticity

Impact

IMPACT OF SPASTICITY ON DAILY LIFE.

In everyday life, patients with spasticity may experience physical symptoms (e.g., pain, contractures, pressure sores), decreased functional abilities, difficulties with mobility, hygiene and care, decreased quality of life, and be prone to developing secondary conditions such as infections and psychological disorders, especially anxiety and depression.

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A multidisciplinary team can help you with treating spasticity

HOW CAN SPASTICITY BE TREATED?

MULTI-MODAL APPROACH FOR SPASTICITY TREATMENT.

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.

More

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