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Spinal Cord Injury Paralysis Resource Center

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Spasticity

Neurons are labeled with different colors in the cerebral cortex of a Brainbow mouse, imaged on a laser-scanning confocal microscope at the Lichtman Lab, Harvard University.

Spasticity is a side effect of paralysis that varies from mild muscle stiffness to severe, uncontrollable leg movements. Generally, doctors now call conditions of extreme muscle tension spastic hypertonia (SH). It may occur in association with spinal cord injury, multiple sclerosis, cerebral palsy, or brain trauma. Symptoms may include increased muscle tone, rapid muscle contractions, exaggerated deep tendon reflexes, muscle spasms, scissoring (involuntary crossing of the legs) and fixed joints.

Photo: Neurons are labeled with different colors in the cerebral cortex of a "Brainbow" mouse, imaged on a laser-scanning confocal microscope at the Lichtman Lab, Harvard University.

When an individual is first injured, muscles are weak and flexible because of what's called spinal shock: The body's reflexes are absent below the level of injury; this condition usually lasts for a few weeks or several months. Once the spinal shock is over, reflex activity returns.

Spasticity is usually caused by damage to the portion of the brain or spinal cord that controls voluntary movement. Since the normal flow of nerve messages to below the level of injury is interrupted, those messages may not reach the reflex control center of the brain. The spinal cord then attempts to moderate the body's response. Because the spinal cord is not as efficient as the brain, the signals that are sent back to the site of the sensation are often over-exaggerated in an overactive muscle response or spastic hypertonia: an uncontrollable "jerking" movement, stiffening or straightening of muscles, shock-like contractions of a muscle or group of muscles, and abnormal tone in the muscles.

Most individuals with SCI have some spasms. Persons with cervical injuries and those with incomplete injuries are more likely than those with paraplegia and/or complete injuries to experience SH. The most common muscles that spasm are those that bend the elbow (flexor) or extend the leg (extensor). These reflexes usually occur as a result of an automatic response to painful sensations.

While spasticity can interfere with rehabilitation or daily living activities, it is not always a bad thing. Some people use their spasms for function, to empty their bladders, to transfer or to dress. Others use SH to keep their muscles toned and improve circulation. It may also help maintain bone strength. In a large Swedish study of people with SCI, 68 percent had spasticity but less than half of those said that their spasticity was a significant problem that reduced activities of daily living or caused pain.

Changing spasticity: A change in a person's spasticity is something to pay attention to. For example, increased tone could be the result of a cyst or cavity forming in the spinal cord (post-traumatic syringomyelia). Untreated, cysts can lead to further loss of function. Problems outside your nervous system, such as bladder infections or skin sores, can increase spasticity.

Treatment for spasticity usually includes medications such as baclofen, diazepam or zanaflex. Some people with severe spasms utilize refillable baclofen pumps, which are small, surgically implanted reservoirs that apply the drug directly to the area of spinal cord dysfunction. This allows for a higher concentration of drug without the usual mind-dulling side effects of a high oral dosage.

Physical therapy, including muscle stretching, range of motion exercises, and other physical therapy regimens, can help prevent joint contractures (shrinkage or shortening of a muscle) and reduce the severity of symptoms. Proper posture and positioning are important for people in wheelchairs and those at bed rest to reduce spasms. Orthotics, such as ankle-foot braces, are sometimes used to limit spasticity. Application of cold (cryotherapy) to an affected area can also calm muscle activity.

For many years doctors have used phenol nerve blocks to deaden nerves that cause spasticity. Lately, a better but more expensive nerve block, botulinum toxin (Botox), has become a popular treatment for spasms. An application of Botox lasts about three to six months; the body builds antibodies to the drug, reducing its effectiveness over time.

Sometimes, surgery is recommended for tendon release or to sever the nerve-muscle pathway in children with cerebral palsy. Selective dorsal rhizotomy may be considered if spasms interfere with sitting, bathing or general caretaking.

Spasticity comes with the territory for many people who are paralyzed. Treatment strategy should be based on one's function: Is the spasticity keeping you from certain activities? Are there safety risks, such as losing control while driving your power chair or car? Are spasticity drugs worse than the symptoms, affecting concentration or energy? Check with your physician to discuss your options.

Sources:
The National Institute of Neurological Disorders and Stroke, National Multiple Sclerosis Society, United Cerebral Palsy Association, The National Spinal Cord Injury Statistical Center, Craig Hospital

Resources:
- Download a FREE PDF fact sheet about spasticity.
- Download a 16-page guide to the causes of and treatments for spasticity.

Medtronic manufactures implantable pumps for ­delivery (intrathecally) of drugs such as baclofen to control spasticity.

National Multiple Sclerosis Society offers information and resources on spasticity.

Craig Hospital, with funding from the National Institute on Disability and Rehabilitation Research (NIDRR), has developed educational materials to help people with spinal cord injuries maintain their health.

A Reeve Foundation Fact Sheet on Spasticity (PDF)

Ask the Neurologist: How to treat spasticityVideo lecture by Leslie Morrison regarding how to treat spasticity. The latest research publications are shown below the lecture updated daily, and with access to some of the full articles.

Exploring SpasicityExploring Spasticity is open to anyone whose life is affected by spasticity. This includes individuals with spasticity, their caregivers, children, or other family members and friends.

The Louis Calder Memorial Library: SpasticityThe mission of the Louis Calder Memorial Library is to support the activities and programs of the University of Miami/Jackson Memorial Medical Center and member institutions and individuals as they relate to education, research, and patient care.

MedtronicMedtronic manufactures implantable pumps for delivery of drugs to control spasticity.

National Multiple Sclerosis SocietyNMSS offers information and resources on all medical issues related to MS including spasticity.

National Organization for Rare DisordersNORD lists numerous diseases that are accompanied by spasticity.

National Institute of Neurological Disorders and StrokeProvides research overviews for all diseases and conditions related to paralysis.

WrongDiagnosis.com: SpasticityWrongDiagnosis.com is one of the world’s leading providers of online medical health information. The site is an independent, objective source of factual, mainstream health information for both consumers and health professionals.

We MovePosts news of clinical advances and therapeutic approaches to the management and treatment of 14 major movement disorders including spasticity.

Paralysis Resource Center The Reeve Foundation Paralysis Resource Center Information Specialists are reachable business weekdays, Monday through Friday, toll-free at 800-539-7309 from 9:00 am to 5:00 pm ET. You may also schedule a call or send a message online.

Reeve Foundation Online Paralysis Community Connecting people living with paralysis, families, friends and caregivers so we can share support, experience, knowledge, and hope.

Quality of Life Grants DatabaseFind resources within the PRC Quality of Life Grants Database. Search by Zip Code, State or an Entire Category.

Library Books and VideosFind resources within the PRC library catalog.

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The Reeve Foundation Paralysis Resource Center Information Specialists are reachable business weekdays, Monday through Friday, toll-free at 800-539-7309 from 9:00 am to 5:00 pm Eastern U.S. Time. International callers use 973-467-8270. You may also schedule a call or send a message online.

This project was supported, in part by grant number 90PR3001, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.