I used to take botulinum toxin. Now I have been using electrostimulation and occupational therapy for over 20 years. Spasticity is weaker than before. Can I get fully rid of the spasticity?

Every therapeutic success—no matter by which method—is welcome. However, it is not yet possible to fully cure spasticity. So far, spasticity is considered irreversible today.

There are many people who benefit from functional electrostimulation (often in conjunction with orthoses, tape or injections) and regular therapy. Overall, there is increasing evidence that a combination of different interventions is more effective in alleviating the symptoms associated with spasticity than an isolated form of treatment.

What factors can worsen my spasticity

The triggering factors for spasticity can vary strongly between individuals. Moods, situations or illnesses might intensify spasticity. 5 These can include:

  • Temperature changes
  • touch
  • tight or uncomfortable clothes
  • physical tension
  • shock, fear
  • fatigue
  • noise of any kind
  • changes of lighting conditions
  • emotional and physical stress
  • sneezing
  • obstipation
  • infection
  • menstrual cycle
  • fever
  • pain
  • thirst, hunger.

5 Phadke CP et. al Revisiting physiologic and psychologic triggers that increase spasticity. Am J Phys Med Rehabil, 2013. 92(4): p. 357-69.

Does the intensity of spasticity depend on the time of day or the weather?

Many patients report that the strength of their spasticity varies with time of day or weather conditions. Low or very warm outside temperatures, storms, sultriness and cold wet weather increase muscle stiffness in many cases.

If the musculature stiffens towards the evening, it might help to postpone or increase the evening medication. Medication should be regularly checked and adapted anyway.

Many patients with spasticity benefit from keeping a regular daily routine. This means, for example, going to bed and getting up at about the same time every day. Muscle complaints often worsen after a short and sleepless night. Regular rest and recovery periods during the day can reduce muscle cramps caused by overload. Patients with spasticity should also pay attention to proper movement and posture patterns. Physiotherapists can give detailed instructions and recommendations.

Does spasticity affect cognitive abilities?

No, spasticity doesn’t affect cognitive abilities. The pathological increase in muscle tension is caused by damage of the central nervous system (brain and spinal cord), but it only affects the ability to move.

Are there symptoms/appearances which can be confused with spasticity? Are they treated in the same way as spasticity?

Spasticity is the result of a lesion in the central nervous system (brain and spinal cord). Increase of muscle tones can be caused by other reasons, for example by Parkinson´s disease, due to lack of electrolyte (especially calcium, magnesium, sodium), metabolic disorders and by tetanus.

The treatment of increased muscle tone always depends on its cause. For example, in the case of a Parkinson’s disease dopamine is missing. The result is an increased tension in the extensor and flexor muscles. This type of muscle stiffness is treated with drugs that increase the level of dopamine in the brain.

A lack of electrolytes can lead to prolonged, painful muscle twitching, similar to spasticity. Once missing minerals are replaced, the troubles will disappear.

During metabolic diseases (both congenital or acquired), disturbances in anaerobic and aerobic energy metabolism can lead to muscle cramps. The therapeutic goal is to normalize the metabolism.

Tetanus has become rare due to existing vaccinations. These are important because in most cases the infectious disease is fatal. The toxins of the tetanus-triggering bacterium Clostridium tetani attack the muscle-controlling nerve cells and cause severe muscle cramps. There is no real causal treatment so far. The best prevention is immunisation with a tetanus vaccine.

Will my limbs ever go back to normal?

This depends on many factors, such as the cause and the extent of the injury to the brain and spinal cord. Through medical and physiotherapeutic treatments the spastic cramps in the muscles (at least in parts) can be solved. This leads to new mobility, which in many cases is accompanied by a high improvement in the quality of life.

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.