OPTA 222 (Spasticity)
What is Spasticity
Velocity dependant increase in the tonic stretch reflexes with exaggerated tendon jerks, resulting from hyperexciability of the stretch reflexes as one component of the upper motor neuron
Pathophysiology
- muscle continuously contracted
- due upper motor neuron lesion
- knee jerk reactin that can't turn off
LMN lesions
-Flaccid paralysis
-Significant atrophy
-Fasciculations and fibrillations present
-Hyporeflexia
-Babinski reflex not presen
UMN lesions
Spastic paralysis
No significant muscle atrophy
Fasciculations and fibrillations not present
Hyperreflexia
Babinski reflex may be present
Tone
The resistance of muscle to passive elongation stretch- tightness during stretch
Rigidity
hypertonic state; constant resistance throughout ROM that is independant of velocity movement
Flexor Type
Flexor is static
Clonus Type
Vibrating back and forth movement
Spastic Paralysis
chronic pathological condition in which the muscles are affected by persistent spasms and exaggerated tendon reflexes because of damage to motor nerves of the CNS
Flaccid Paralysis
weakness or loss of muscle tone resulting from injury or disease of the nerves innervating the muscles
why we check for spasticity
-As a clinician, it indicates an increased severity of injury
-Helps us think about functional goals in future
-As a neurologist, it indicates upper motor neuron (UMN) lesion
-Spasticity interferes with normal muscle function
Signs and symptoms
-Joint stiffness
-Muscle stiffness
-Exaggerated muscle jerks
-Abnormal posture
-Abnormal position of affected limb (ie. fingers, wrist elbow etc.)
-Pain
Note: these signs and symptoms can worsen over time and can make simple tasks no longer possible
Issue due to Spasticity
-Spasticity often leads to pain and discomfort
-Can permanently decrease soft tissue length (contracture)
-Can decrease skin integrity if contracture forms
Treatment
-Goal is to maintain muscle length
Do this by:AROM, PROM, Splinting, Pharmacologically( Baclofen and Botulinum toxin), FES( flexer electical stim)
- worsens with heighten emotional states; educate triggers, and relaxation techniques