Spasticity

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Spasticity is a condition in which certain muscles are continuously contracted. This contraction causes stiffness or tightness of the muscles and may interfere with movement, speech, and manner of walking.

Causes of Spasticity?

Spasticity is usually caused by damage to the portion of the brain or spinal cord that controls voluntary movement.

It may occur in association with spinal cord injury, multiple sclerosis, cerebral palsy, damage to the brain because of lack of oxygen, brain trauma, severe head injury, and metabolic diseases such as adrenoleukodystrophy, amyotrophic lateral sclerosis (Lou Gehrig's disease), and phenylketonuria.

Symptoms of Spasticity

Symptoms may include hypertonicity (increased muscle tone), clonus (a series of rapid muscle contractions), exaggerated deep tendon reflexes, muscle spasms, scissoring (involuntary crossing of the legs), and fixed joints. The degree of spasticity varies from mild muscle stiffness to severe, painful, and uncontrollable muscle spasms.

How is Spasticity Diagnosed?

Your child's doctor and a physical therapist will evaluate your child. During the evaluation, a videotape record of movement is made. Its helpful while the child is being treated to review this tape to judge the effectiveness of the treatment.

Spasticity Treatment

Medications, surgery and physical therapy might all be used to treat your child, depending on the severity of the condition.

Physical therapy regimens may include muscle stretching and range of motion exercises to help prevent shrinkage or shortening of muscles and to reduce the severity of symptoms.

Surgery may be recommended for tendon release or to sever the nerve-muscle pathway.

Your child's physical therapist might recommend aquatic therapy. By using a pool heated to 92 to 96 degrees, the therapist continuously supports your child's body. This enables deep relaxation and allows for the expansive movement of the spine and body.

Myofascial release is a highly specialized stretching technique that has been proved successful in treating some spasticity cases. The fascia is a specialized system of the body that has an appearance similar to a spiders web. The fascia is very densely woven, covering and interpenetrating every muscle, bone, nerve, artery and vein, as well as all of our internal organs, including the heart, lungs, brain and spinal cord. When muscle fibers are injured, the fibers and the fascia which surrounds the muscles become short and tight.

Physical therapists can use this stretching technique to release the uneven tightness in the injured fascia which can reduce pain.

Botox Treatment Botox is a substance that can be locally injected into specific muscles that are spastic (muscles that are tight). It works by paralyzing the injected muscle. Botox does not cure spasticity, but helps to decrease the tightness in muscles that have had an injection. It lasts anywhere from three to six months.

What Can I Do as a Parent?

There are several different approaches to help manage spasticity in children who have tight muscles. Here is a list of some options:

• Handling/Positioning:
  Children who tend to extend: carry them in a fetal position, or on their side with one of your arms in between their legs. When sitting, have their knees above their hip joint, have them work on using tummy muscles, like in games reaching for their toes and knees when lying on their back. For children that point their toes and make it difficult to get their orthoses on, you can try bending their knee and hip and take the ball of their foot and turn it inward and up to try and decrease spasticity.
  
  Weight bearing through the arms and legs can decrease spasticity. What this means is the child is supporting his or her weight through all the joints of the arm, including the shoulder, elbow, and possibly the wrist. An example would include, a child lying on his or her belly, pushing up on their hands or elbows to look up, or a child crawling on his or her hands and knees. Weight bearing through the legs means the child is supporting his or her weight through the hips, knee, and possibly the ankle. This could be as simple as standing up at the couch or kneeling while crawling around.
  
  Rotating the trunk can help decrease spasticity.
  
• Medication: Some medications can help decrease spasticity, such as oral Baclofen, Tizanidine, or Dantrolene. Baclofen can also be administered in a pump form, where an actual pump is surgically placed inside a child's abdomen. It is the size of a hockey puck and releases medicine on a 24-hour basis into the child's spinal canal. It needs to be refilled about every 8-12 weeks. There is also injectable medications, such as Botox or Phenol, that can decrease spasticity as well.
  
• Heat, like a warm bath, can help decrease spasticity and may make it easier to stretch.
  
• Stretching the spastic muscles to try and gain, or at least maintain, the flexibility the muscle has can help.
  
• Electrical stimulation: A machine that can deliver electrical stimulation to a muscle through electrodes to cause it to tighten and contract, thus possibly improving muscle activity.
  
• Orthoses: Custom-made braces, made from a variety of materials, can be worn during the day or night.
  
• Serial casting: When a child's muscles are short due to spasticity, like in the gastrocnemius (calf muscle), a cast can be made to go over the ankle and knee joint with the muscle placed in a stretched position. This method is often used after Botox injections. Each week, the cast is removed and the muscle is stretched maximally each week. This process is repeated usually for six to eight weeks to stretch a given muscle. Splints and orthotics are used after serial casting to maintain the newly gained flexibility.
  
• Splinting: A custom-made brace is used to provide a prolonged muscle stretch. This is usually worn at night.
  
• Dorsal Root Rhizotomy: A rhizotomy is a spinal operation where a neurosurgeon cuts the dorsal root nerves that are abnormal and involved with the spasticity. It requires extensive physical therapy after surgery.
  
• Orthopedic Surgery: Spasticity can cause severe joint malalignment, as well as contractures (muscles that are so tight they cannot be straightened out). Surgery can lengthen muscles, relocate tendons, fuse bones, and change bones (osteotomy) to help improve a child's function.
   

Where Can I Get More Information?

March of Dimes Foundation
1275 Mamaroneck Avenue
White Plains, NY 10605
Phone 914-428-7100 or 888-MODIMES (663-4637)
Fax 914-428-8203
E-mail askus@marchofdimes.com
Website: www.marchofdimes.com

National Multiple Sclerosis Society
733 Third Avenue
6th Floor
New York, NY 10017-3288
Phone 212-986-3240 or 800-344-4867 (FIGHTMS)
Fax 212-986-7981
E-mail nat@nmss.org
Website: www.nationalmssociety.org

National Organization for Rare Disorders (NORD)
P.O. Box 1968
(55 Kenosia Avenue)
Danbury, CT 06813-1968
Phone 800-999-NORD (6673)
203-744-0100 (Voice Mail)
Fax 203-798-2291
E-mail orphan@rarediseases.org
Website: www.rarediseases.org

United Cerebral Palsy (UCP)
1660 L Street, NW
Suite 700
Washington, DC 20036
Phone 202-776-0406 or 800-USA-5UCP (872-5827)
Fax 202-776-0414
E-mail national@ucp.org
Website: www.ucp.org

WE MOVE (Worldwide Education & Awareness for Movement Disorders)
204 West 84th Street
New York, NY 10024
Phone 212-875-8312 or 866-546-3136
Fax 212-875-8389
E-mail wemove@wemove.org
Website: www.wemove.org

Easter Seals
230 West Monroe Street
Suite 1800
Chicago, IL 60606-4802
Phone  312-726-6200 or 800-221-6827
Fax 312-726-1494
E-mail info@easterseals.com
Website: www.easterseals.com

Part of this information has been prepared by the National Institute of Neurological Disorders and Stroke and the National Institutes of Health.

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