Spasticity is a constant contraction of one or more muscle groups that occurs when communication between the central nervous system (brain and spinal cord) is disrupted by an injury such as a stroke, spinal cord trauma, brain injury, multiple sclerosis, or other illnesses that affect the brain and spinal cord.
Spasticity cause pain, fatigue, mobility issues and can become a major barrier to a persons daily activities such as walking, sitting, positioning, and sleep. If a patient has significant disability associated with spasticity, it can even impair the ability of the caregiver to provide necessary hygiene and care.
Exercise- Physical and occupational therapy is an essential part of any spasticity management program. They teach proper stretching, positioning and exercise activities that can help maintain range of motion and prevent shortening or tightening of the muscles also known as a contracture.
Oral medications - There are several medications for spasticity that can be considered and are prescribed based on several factors. Typically baclofen is 1st line therapy and supplemented with other medications. The dose and combination of anti-spasticity medications is dependent on individual response and degree of side effects experienced.
Intrathecal therapy - Some patients cannot tolerate the oral medications due to side effects and can benefit from medication delivered directly into the fluid surrounding your spinal cord. The medication is delivered via an implantable pump and catheter system. The implantation requires a surgical process and the pump must be refilled at regular intervals. This type of therapy can be very beneficial for certain combinations of spasticity, especially in the legs but requires a high level of responsibility on behalf of the patient or caregiver. There can be severe withdrawal from the medication if the pump is allowed to run empty and risk of infection.
Injections - Botulinum toxin injections into affected muscles can decrease the muscle signals that cause spasticity. Unlike the oral medications that mostly work through interaction in the brain and spinal cord, botulinum toxin therapy works at the junction of the nerve to the muscle decreasing the overactive signalling. The injections provide temporary relief, allowing you to move and strengthen your muscles. You may have injections every three months. Adjunctive injections with phenol or alcohol into your peripheral nerve near the spastic muscles may reduce your muscle spasms.
Bracing - Can be used to help provide prolonged stretch to a particular group of muscles (i.e. hand.wrist) or provide assistance with mobility (i.e. ankle foot orthosis)
Surgical procedures - Neurosurgical procedures are used to target and to destroy (ablate) particular parts of the spinal roots to reduce or stop the spasticity. Orthopedic surgical procedures are used to either lengthen or cut tendons of contracted muscles that are causing decreased range of motion or pain.