Symptoms and clinical patterns

Symptoms

Spasticity is usually a permanent symptom that can range from very mild to debilitating and painful.

The main symptoms are:

  •  Increased muscle tone
  • Overactive reflexes

Individual consequences of spasticity

These can lead to:

  • Involuntary movements which may include:
    • Spasms: brisk and/or sustained involuntary muscle contraction that can hinder the movements and sometimes be painful
    • Clonus: a series of fast involuntary contractions
    • Co-contractions: involuntary movement of one limb or part of a limb while another limb/part of the limb is moved
  • Contractures: permanent contraction of the muscle and tendon due to severe persistent stiffness and spasms
  • Abnormal posture that can generate difficulties e.g., in limb positioning or cleaning hand
  • Bone and joint deformities
  • Pain

Episodes of spasticity can range from very mild to debilitating and painful.

The main symptoms are:

  • Increased muscle tone
  • Overactive reflexes

These can lead to:

  • Involuntary movements which may include spasms (brisk and/or sustained involuntary muscle contraction, that can hinder the movements and sometimes be painful) and clonus (a series of fast involuntary contractions)
  • Contractures (permanent contraction of the muscle and tendon due to severe persistent stiffness and spasms). Such contractures are not accessible to botulinum toxin injections anymore and must be released with orthopedic surgery
  • Abnormal posture that can generate difficulties e.g. in limb positioning or cleaning hand
  • Bone and joint deformities
  • Pain

Spasticity can occur in the upper and/or 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. Thus, the patients can move the impaired side of their body, but with reduced muscular strength. This can be associated with other deficits like decrease of sensibility and/or decrease of body part position perception. Hemiplegia is more severe and defined as total absence of controlled movement. In most of the cases, the upper limb is affected, while the lower limb is affected in approximately 66% of the cases
  • In 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 two upper limbs
  • All four limbs are affected in patients with spastic quadriplegia. This is mainly related to a lesion of the spinal cord

While spasticity may affect any muscle group, it often produces stereotypical postural patterns.
Spasticity frequently affects muscles that work against the force of gravity. In other words, in the arm area, it tends to affect the flexors (biceps, brachialis and brachioradialis).

Common clinical patterns of upper limb spasticity include:

  • Adducted, internally rotated shoulder: the arm is drawn to the body and turned inwards
  • Flexed elbow: the wrist and hand are held near to the shoulder
  • Pronated forearm: inward rotation of the forearm
  • Flexed wrist: wrist is bent
  • Clenched fist: fingers are clasped tightly into the palm
  • Thumb-in-fist: thumb pulled into the palm and unable to function

These can all affect the person’s ability in simple everyday tasks like dressing, eating or grasping, and may interfere with balance, causing difficulties with mobility.

Spasticity often produces stereotypical postural patterns depending on the muscles affected by increased muscle tone.

As already mentioned, spasticity frequently affects muscles that work against the force of gravity. In other words, in the leg, it tends to affect the extensors.

Common clinical patterns of lower limb spasticity include:

  • Hip flexion: hip is flexed, the body is bent forward
  • Adducted thighs: the inner parts of the thighs are pressed closely together
  • Knee extension (stiff knee): hyperextended knee joint, the lower leg is extended
  • Knee flexion: flexion of the knee joint, the lower leg is bent
  • Equinovarus foot: toe walking with raising of the heel and inward flexion of the entire foot
  • Striatal toe (extension of the big toe): the toe is stretched upwards

How Karl’s life is influenced by spasticity

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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