SPASTICITY

INTRODUCTION:

Spasticity of Muscles is a feature of altered skeletal muscle performance with a combination of paralysis, increased tendon reflex activity and hypertonia.
It is also colloquially referred to as an unusual “tightness”, stiffness, or “pull” of muscles.

Functional definition: The abnormal motor control caused by an UMN lesion (as in spastic paraparesis).

Positive Signs:

Spasticity
Rigidity
Hyperreflexia
Primitive reflexes
Clonus

Negative Signs:

Lack of strength
Lack of motor control
Lack of coordination

EXAMPLE OF UPPER MOTOR NEURON DISEASE:

Stroke
Multiple Sclerosis
Cortico basal Ganglionic Degeneration
Traumatic Brain Injury
Acquired Brain Injury
Spinal Cord Injury
Cerebral Palsy

CAUSES:

Spasticity is caused by an imbalance of signals from the central nervous system (brain and spinal cord) to the muscles.
This imbalance is often found in people with cerebral palsy, traumatic brain injury, stroke, multiple sclerosis, and spinal cord injury.

SIGNS AND SYMPTOMS:

Increased muscle tone.
Overactive reflexes.
Involuntary movements, which may include spasms (brisk and/or sustained involuntary muscle contraction) and clonus (series of fast involuntary contractions).
Pain and discomfort.
Decreased functional abilities and delayed motor development.
Difficulty with care and hygiene.
Abnormal posture.
Contractures (permanent contraction of the muscle and tendon due to severe persistent stiffness and spasms).
Bone and joint deformities.
Skin breakdown-shear.
Interferes with breathing.
Hampers gait and transfer.
More work for caregiver.
Poor safety.
Sexual difficulties.
Insomnia.
Poor posture.

PATHOPHYSIOLOGY:

ASSESSMENT:

Patient report.
Deep tendon reflexes.
Passive range of motion.
Test for clonus.
Functional observation:
Determine nature of hypertonicity
Assess interference with function (gait) and effect of stress and/or fatigue
Assess adaptive shortening of muscles vs. irreversible contracture
Consider aggravating factors. (e.g., UTI, infection, excessive activity, strengthening exercises)

MODIFIED ASHWARTH SCALE:

DEFINITION:
The Modified Ashworth scale (MAS) measures resistance during passive soft-tissue stretching and is used as a simple measure of spasticity.

Scoring of modified Ashwarth scale:

0 No increase in muscle tone
1 Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the range of motion when the affected part(s) is moved in flexion or extension.
1+ Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM.
2 More marked increase in muscle tone through most of the ROM, but affected part(s) easily moved.
3 Considerable increase in muscle tone, passive movement difficult.
4 Affected part(s) rigid in flexion or extension.

CONSIDERATIONS IN REDUCING SPASTICITY OF MUSCLES :

Possible advantages of spasticity :

Maintains muscle tone/bulk.
Helps support circulatory function.
May prevent formation of deep vein blood thrombosis.
May assist in activities of daily living.
May assist with postural control.

REHABILITATION INTERVENTION:

Static stretch.
Gait training (emphasis on swing and heel strike).
Positioning/posture.
Cooling.
Patient education.
Relaxation.
Bio-feedback: These techniques involve monitoring muscle activity via a device that records when a spastic muscle relaxes or contracts.
Facilitation: This includes neurodevelopmental therapy (also known as Bobath approach) aimed at reducing inappropriate reflexes and training the muscles to achieve normal balanced reactions. Proprioceptive neuromuscular facilitation seeks to retrain spastic muscles for normal motion. Sensory integration involves continually repeating tasks, often with the therapist directing the limb while you remain passive, so that the brain is “retrained” in the proper movements.
Reflex-inhibiting movement patterns.
Avoiding noxious stimuli.
Medications.

PHYSIOTHERAPY MANAGEMENT:

Reduction of noxious stimulation.
Positional Stretching and weight bearing Activity.
Muscle Long Stretching.
Physical modalities like,
Cooling- Icing.
Heat.
Electrical stimulation: Electrical stimulation is sometimes used to re-educate muscles, usually with the goal of resetting the balance between the flexor and extensor muscles. The effects usually last for about 10 minutes when the stimulation is first applied, but after several months the effects may become longer lasting.
Muscle strengthening.
Orthoses: Also known as casts, braces, or splints, orthoses include any device that is used to support, align, prevent, or correct deformities or improve the function of movable parts of the body. When used to treat spasticity, orthoses may reduce muscle tone, increase or maintain motion, and prevent skin damage such as the breakdown that would occurs in palm if fist is continually clenched.

THOSE ABOVE ARE COLLECTED FROM SOME BOOKS AND WEBSITES..

THANK YOU,

SRIKUMARAN PHYSIOTHERAPY CLINIC & FITNESS CENTER

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முதுகு வலி மற்றும் முதுகு தண்டுவட வலி உள்ளவர்களுக்கு கடைபிடிக்க வேண்டிய சில வழிமுறைகள்....

முதுகு வலி மற்றும் முதுகு தண்டுவட வலி உள்ளவர்களுக்கு கடைபிடிக்க வேண்டிய சில வழிமுறைகள் .... பொதுவாக முதுகு வலி என்பது இன்றைய காலகட்டத்தில் பல பேருக்கு மிக அதிகமாகவே காணப்படுகிறது. இவ்வாறு வலி இருக்கும் பொழுது என்ன மாதிரியான வழிமுறைகளை கடைப்பிடிக்க வேண்டும் என்பதை கீழே விரிவாக பார்க்கலாம். பொதுவாக முதுகு வலி ஆரம்பிக்கும் பொழுது அவற்றை உதாசீனப்படுத்தாமல் அருகில் உள்ள மருத்துவரை அணுகி ஆலோசனை பெறுவது மிகவும் முக்கியம். மேலும் முதுகு வலி ஏற்படும் பொழுது அவற்றுக்கு தேவையான மருத்துவம்(medical management), இயன்முறை மருத்துவம்(physiotherapy treatment), பயிற்சிகள்(exercises) அல்லது அறுவை சிகிச்சை(surgery) மற்றும் புனர்வாழ்வு சிகிச்சைகள்(Rehabilitation) போன்றவை தேவைப்படலாம். மேலே கண்ட மருத்துவத்தில் ஏதாவது ஒன்றை எடுத்துக் கொள்ளும் பட்சத்தில் மேலும் முதுகு வலி வராமல் பாதுகாத்துக் கொள்ளவும், நமது அன்றாட வேலைகளை தொடர்ந்து செய்யவும், மருத்துவ உபகரணங்களை பயன்படுத்திக் கொள்ளவும்...

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SRIKUMARAN PHYSIOTHERAPY & FITNESS CENTRE ( ஶ்ரீகுமரன் ‌‌‌‌பிசியோதெரபி & உடற்பயிற்சி மையம் )

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