Spasticity: Symptoms, Causes and Treatments

The Spasticity Is a medical condition in which there is an abnormal increase in muscle tone, ie, muscle stiffness.

This symptom often interferes with movement, language production, and is associated with postural pain or discomfort (National Institute of Neurological Disorders and Stroke, 2011).

Typically, spasticity is usually considered a Motor-type disorder Associated with various diseases and disabilities (Convives with Spasticity, 2009).

The cause of spasticity is in the presence of damage or injury to the nerve pathways that control muscle movements (National Institute of Neurological Disorders and Stroke , 2011), causing an increase in muscle tone and therefore, making it difficult or impossible Partial / total movement of the affected muscle groups (Convives with Spasticity, 2009).

In addition, spasticity usually appears as one of the symptoms of some of the following medical pathologies: spinal cord , multiple sclerosis , cerebral palsy, stroke, Traumatic brain injury , Amyotrophic Lateral Sclerosis , Spastic paraplegias Diseases and some metabolic pathologies such as Adrenoleukodystrophy , the Phenylketonuria , and the Krabbe disease (National Institute of Neurological Disorders and Stroke, 2011).

At the clinical level, the symptomatic picture of spasticity can range from hypertonia (abnormal muscle tone), clonus (Rapid and sudden muscle contractions), exaggerated reflexes, muscle spasms, involuntary closure of the legs, to the presence of Contractures (National Institute of Neurological Disorders and Stroke, 2011).

In some cases, spasticity may present as mild muscle stiffness, however, in many others intense muscle spasms occur, Painful and uncontrollable (National Institute of Neurological Disorders and Stroke, 2011).

This medical condition can significantly interfere with activities such as walking, eating, talking, etc. The evolution of physical rehabilitation for certain pathologies (National Institute of Neurological Disorders and Stroke, 2011).

What is spasticity?

Spasticity is a motor-type disorder in which certain muscle groups contract continuously, causing muscle tension and stiffness (American Association of Neurological Surgeons, 2006).

Spasticity may be mild, tenderness in the muscles or aggravated producing significant muscle stiffness, Involuntary spasms or sudden movements (National Multiple Sclerosis Society, 2016).

Usually, this disturbance can cause pain or discomfort and interfere with the activities of daily living being an obstacle to walking, sitting, Adopt comfortable postures and even sleep (Mayo Clinic, 2014).

People with this pathology often describe it as:"feeling of heaviness and stiffness in the legs or arms","stiff legs"," As if it carried several kilos in the legs or in the arms","difficulty to raise the feet when walking", etc. (Medical Editors, 2013).

In addition to the term spasticity, in the medical field others are often used as Muscle stiffness or Hypertonia for Refer to this pathology (University of Maryland Medical Center, 2011).

In the case of hypertonia, health professionals define it as a pathological elevation of muscle tone, that is, a contraction Of a muscle and distinguish two types (Medical Editors, 2013):

• Static: Elevated muscle tone is present independently of body activity, it can be observed in any position.
• Dynamic: Muscular rigidity is only present in specific situations and is usually variable. Usually appears when a change of position is made, before the
  Presence of painful stimuli or when performing voluntary movements, among others.

Who is affected by spasticity?

Spasticity can affect anyone outside their age group, gender, or other sociodemographic characteristics. Therefore, we can To find cases of spasticity in children, adolescents, adults or elderly (Convives with Spasticity, 2009).

The profile of clinical affectation is usually extremely varied since it is a motor disorder that is found within the symptomatology of a wide Variety of pathologies, both congenital, acquired, and neurodegenerative (Convives with Spasticity, 2009).

The American Association of Neurological Surgeons (2006) notes that spasticity affects approximately 12 million people worldwide, The most prevalent causes being cerebral palsy and multiple sclerosis.

Specifically, spasticity is considered one of the most common symptoms in Multiple Sclerosis (MS). A study of the North American Consortium of Multiple Sclerosis (2001), showed that approximately 84% of people surveyed with MS had spasticity at some point in their course (Medical Editors, 2013).

In the case of cerebral palsy, it is estimated that approximately 80% of those affected present varying degrees of spasticity. In United States, About 400,000 people could be affected (American Association of Neurological Surgeons, 2006).

What are the symptoms?

Although the symptoms of spasticity vary considerably among those affected, we can point out some of the most common ones (MSKTC, 2011):

• Involuntary and sudden sprains or extensions of one of the limbs.
• Tugs in larger muscle groups: chest, back, abdomen, etc.
• Muscle spasms or hyperactive reflexes.
• Muscle stiffness in rest state.
• Difficulty relaxing or stretching muscle groups.
• Tension of various muscle groups during activity.
• Difficulty or inability to control voluntary movements.
• Clonus: involuntary, repetitive and rhythmic contraction / relaxation of the affected musculature.
• Muscle and joint pain.

Which body areas are most affected?

Although it can affect large muscle groups, spasticity is more common over (Medical Editors, 2013):

• Lower extremities : In the case of the legs, spasticity mainly affects the extensor muscles of the quadriceps, twins and adductors of the hip.
• Superior limbs : In the case of the arms, spasticity mainly affects the flexor muscles of the fingers, wrist, biceps and adductors of the shoulder.

For this reason, it is also possible to observe abnormal postural patterns: hip flexed inwards, tip of feet down, knees Flexed, among others (Medical Editors, 2013).

What is the cause?

The nerve connections between the spinal cord and the brain are part of a complex information transmission circuit that controls Our movements (MSKTC, 2011).

All information about processes and sensations such as touch, movement or muscle stretching is transmitted from the spinal cord To the brain (MSKTC, 2011).

The brain is responsible for interpreting all the information that comes to him and elaborates a response in the form of instruction through the spinal cord, Controlling this way our movements (MSKTC, 2011).

When injuries and significant damage to the nerve pathways involved in controlling movement and muscle groups occur, one of the Symptoms that may develop is spasticity (National Institutes of Health, 2015).

After an injury, the normal flow of information-response is broken, I could not get the message to the brain or it does not produce a response Efficient (MSKTC, 2011). Therefore, spasticity can occur when damage occurs at both the brain and spinal cord (National Institutes Of Health, 2015).

When lesions are restricted to brain areas, spasticity will fundamentally affect upper limb flexion and extension of The lower ones; On the contrary, if the lesion affects different areas of the spinal cord, spasticity will be observed in the form of flexion and Adduction of the upper limbs (Convives with Spasticity, 2015).

In the case of spasticity, several pathologies have been described that will affect the pathways that control movement:

• Cerebral Palsy (PC).
• Multiple Sclerosis (MS).
• Cranioencephalic trauma (TBI).
• Ictus .
• Injuries to the spinal cord.
• Encephalitis .
• Meningitis .
• Amyotrophic lateral sclerosis (ALS).
• Phenylketonuria.

Is spasticity always present?

The severity of spasticity varies widely, from mild to moderate to severe. It is also a variable medical condition throughout the day, In many cases, its occurrence depends on the position or activity being performed (Convives with Spasticity, 2009).

In addition, environmental and psychological factors also have an influence on pain perception (Convives with Spasticity, 2009).

Are there factors that increase muscle tone or spasticity?

Some events, actions or circumstances that have increased the severity and occurrence of spasticity have been identified (MSKTC, 2011):

• Move legs or arms.
• Stretch your muscles.
• Skin pathologies: irritation, redness, hives, etc.
• Pressure ulcers.
• Full bladder or urinary tract infection.
• Constipation.
• Fractures and other muscle injuries.

How is it diagnosed?

When a person suffers from any of the aetiological conditions mentioned above (cerebral palsy, MS, etc.), both weakness Such as muscle hypertonia.

The precise diagnosis of spasticity requires both the detailed elaboration of the patient's medical history and the performance of a physical examination detailed.

Many medical specialists consider that the following areas should be evaluated (Convives with Spasticity, 2015):

• Muscular tone : Through the Ashworth scale Modified.
• Joint balance : Through the measurement of joint angles.
• Selective motor control : Through observation of the ability to perform different movements.
• Functional capacity : Is measured through the performance of activities of daily living.
• Analysis of the march : Is measured by direct observation of the gait.
• Muscle spasms : Through the Scale of spasms.
• Pain : Through the Visual analogue scale .
• Subjective global assessment : Through a Likert rating scale.
• Observation Pattern : Through the physical examination.

What are the associated complications?

In many of the people with spasticity there are a number of problems or negative aspects associated with this medical condition (Convives with Spasticity, 2015):

• Difficulty or inability to perform actions that involve voluntary muscular activity.
• Presence of abnormal postural patterns.
• Difficulty walking, impaired gait.
• Difficulty or inability to perform many of the routine activities of daily living (eating, bathing, dressing, etc.).
• Development of contracture, muscle spasms, muscle and joint pain.
• Difficulty to urinate and defecate, urinary incontinence.
• Increased likelihood of fractures, bone and joint malformations, pressure ulcers.
• At the psychological level, it can favor the isolation and development of depressive symptomatology.
• Significant decrease in quality of life.
• Difficulty in effectively developing a rehabilitative treatment.

Despite this, spasticity Can also be beneficial in some cases:

• It improves or decreases muscle atrophy due to the disuse of various muscle groups.
• Reduces swelling or edema in the legs that occur as a result of immobility.
• It reduces the risk of suffering from Venous thrombosis In the lower extremities.
• Decreases muscle weakness in the legs and promotes standing.
• It favors the withdrawal reflex before a stimulus that causes pain.
• It decreases the probability of hypotension favoring the control of blood pressure.

Are there any treatments?

There are several therapeutic interventions aimed at treating the symptoms and complications of spasticity. This should be treated when pain and Muscle stiffness negatively interferes with both the routine activities and the quality of life of the affected person (Cleveland Clinic, 2015).

In general, the treatment of spasticity usually involves a large group of specialists including: neurologist, physiotherapist, Occupational therapist, neurosurgeon, orthopedic surgeon, among others (Cleveland Clinic, 2015).

At the clinical level, spasticity can be treated through pharmacological and non-pharmacological approaches.

Non-pharmacological therapeutic intervention

The intervention or physical treatment is aimed at reducing the symptoms of spasticity (MSKTC, 2011):

• Regular stretching activities help improve flexibility and reduce muscle tension.
• Exercises with weight or in vertical position, also allow to improve the muscular flexibility.
• The use of prostheses, splints or other orthopedic measures can modify the presence of abnormal postures and improve the frequency of presentation Of muscle spasms.
• The use of heat / cold is also beneficial for reducing muscle tone.

These and other physical intervention measures must be controlled and supervised by a specialist, usually physiotherapists are the Responsible for implementing rehabilitation programs in health care services.

Pharmacological therapeutic intervention

Intervention through drugs is used when physical therapy is not effective. If there is extensive involvement of various body areas, the Doctors may prescribe oral drugs such as baclonene, Benzodiazepines , Dantrolene or tizanidine.

Although they often produce benefits in many cases, they also carry a number of side effects such as drowsiness, tiredness, fatigue, Weakness or nausea.

References

1. AANS. (2016). Spasticity . Retrieved from the American Association of Neurological Surgeons.
2. Cleveland Clinic. (2015). Spasticity . Obtained from Cleveland Clinic.
3. Clinic, M. (2014). Spasticity management for spinal cord injury . Obtained from Mayo Clinic.
4. Convives. (2009). What is Spasticity? Obtained from Convives with Spasticity.
5. Physicians, E. (2013). Exercise Guide to Improve Spasticity in Multiple Sclerosis . Obtained from Multiple Sclerosis.
6. MSKTC. (S.f.). Spasticity and Spinal Cord Injuries . Obtained from Model Systems Knowledge Translation Center.
7. NIH. (2015). Spasticity . Obtained from MedlinePlus.
8. NIH. (2011). Spasticity Information Page . Retrieved from the National Institute of Neurological Disorders and Stroke.
9. Tecglen, C. (2015). Guide For people living with Spasticity. Madrid: National University of Distance Education.
10. UMMC. (2015). Spasticity . Retrieved from University of Maryland Medical Center.