Spasticity

What Is Spasticity?

Sometimes spasticity is called tone or just “tight muscles”. Funnily enough, there is not one definition for spasticity (Ward, 2012).  What you, as a stroke survivor, experiences is that some muscles are very strong and highly excitable and others are weak. Many stroke survivors find that if they cough their arm tightens or if they start to walk faster their toe drops and they will sometimes trip on their toe.

Post-stroke spasticity is highly variable.   Stroke spasticity does not conform to many of the standard definitions for spasticity.

More information:

• Ward’s (2012) Review Of Spasticity if you prefer the scientific version.
• StrokEngine  This is the Canadian Stroke Networks website for families and health professionals.
• Wikipedia also has information on Spasticity. 

Treatment to Reduce Spasticity

This section is just meant to provide you with a very brief overview of treatments for spasticity, mainly some keywords for you to look for if you have spasticity.

According to the Canadian Stroke Network best practices, spasticity and contractures should be treated or prevented by antispastic pattern positioning, range-of-motion exercises, stretching and/or splinting (Canadian Stroke Network, StrokEngine).

The treatment by health professionals is designed to strengthen weak muscles and relax the strong and over-excitable muscles.   Check  StrokEngine and  the U-tube videos for more information and demonstrations of various techniques for reducing spasticity.

The first line of treatment is exercise, but splinting, muscle relaxant medications (Baclofen and  Botox), functional electric stimulation,  and Transcranial Magnetic Stimulation or repetitive  Transcranial Magnetic Stimulation (rTMS)  are also options. You might ask your health professionals about using treatment combinations -- for example you may want to use exercise, constraint therapy, and Botox.

Exercise: A physiotherapist, occupational therapist, or kinesiologist with training in stroke should show you how to stretch tight muscles and strengthen weak muscles.  Constraint therapy and robotic therapy can make the exercise more intensive and sometimes more interesting.

Splints and Stretching

Splints passively stretch tight muscles and may prevent contractures.   The ankle foot orthosis can help keep your foot and toe in the right position so you can walk better.  Check with your health professionals to see what would work best for you.

Splints and AFO’s don’t need to be expensive; many are actually preformed and can be ordered online. Ask your therapist about the right type and size for you.

• Allegro Medical (United States only). They have Hand Splints.
• Patterson Medical (Canada). They have Thermoplastic Hand Splints and AFO’s.

Medications

There are several medications that attempt to dampen the signals between nerve and muscle.   Sometimes muscle relaxant medications as baclofen, or dantrolene are used. These relax all the muscles, both tight and weak muscles, so make sure you talk to your health professional about the pros and cons of these medications for you.  Another option is Botox or botulinum toxin

Robert Teasell and his team in London, Ontario reviewed the evidence for use of Botox to reduce spasticity. There is strong evidence that Botox is an effective treatment to reduce focal tone, spasticity, and helps to reduce pain from very tight, spastic muscles.  In other words — it will relax those tight muscles into which the Botox was specifically injected.

There is not as much evidence that Botox increases function in arms or legs.  One review provides strong evidence that Botox administration associated with a small, but significant improvement in gait velocity.  However, it is important to note that in many of these studies, the research just administered Botox and didn’t provide physio or occupational therapy or provide exercises.   More research which tests Botox with other interventions like constraint therapy or robotic therapy is needed.

Reference: Teasell et al. (2012). Evidence to Practice: Botulinum Toxin in the Treatment of Spasticity Post Stroke: TOPICS IN STROKE REHABILITATION, 19 (2)  115-121  

Spasticity is often used as an indicator of stroke severity and how much function you will get. 

In a recent review, the best predictor of arm recovery was how severely the arm was affected to begin with.  However, one can question whether that finding starts with the assumption that the arm is severely affected so there is little or no therapy for the arm.

See the article Review of Arm Recovery.