Spasticity: Difference between revisions
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== Clinical Presentation == | == Clinical Presentation == | ||
When the | When the brain or spinal cord is damaged, the stretch reflex can be insufficiently inhibited. An exaggerated reaction in the muscle could occur, which can lead to spasticity. This spasticity is clinically observable and measurable in rest. <ref name="Lance" /><br>Important problems that rise because of spasticity are for example limited joint movement, abnormal postures that can produce pain, impaired functional capacity, aesthetic or hygiene disorders. Spasticity is frequently present in childhood, mainly because of cerebral palsy, and in adults, which is mostly caused by traumatic brain injuries, strokes and spinal cord injuries. <ref name="Gracies">Gracies JM, Bayle N, Vinti M, Alkandari S, Vu P, Loche CM, Colas C. Five-step clinical assessment in spastic paresis. Eur J Phys Rehabil Med. 2010 Sep;46(3):411-21.</ref><br> | ||
== Diagnostic Procedures == | == Diagnostic Procedures == | ||
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Definition [edit | edit source]
- The most well-known and referenced description of spasticity is the physiological definition proposed by Lance in 1980:[1]
Spasticity is a motor disorder characterised by a velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex, as one component of the upper motor neurone syndrome.
- Spasticity as described by European working group, EUSPASM [2] is "disordered sensorimotor control,resulting from an upper motor neurone lesion, presenting as intermittent or sustained involuntary activation of muscles.
- Spasticity is a velocity-dependent disorder of the stretch reflex that results in increased muscle tone. [3]
Clinical Presentation[edit | edit source]
When the brain or spinal cord is damaged, the stretch reflex can be insufficiently inhibited. An exaggerated reaction in the muscle could occur, which can lead to spasticity. This spasticity is clinically observable and measurable in rest. [3]
Important problems that rise because of spasticity are for example limited joint movement, abnormal postures that can produce pain, impaired functional capacity, aesthetic or hygiene disorders. Spasticity is frequently present in childhood, mainly because of cerebral palsy, and in adults, which is mostly caused by traumatic brain injuries, strokes and spinal cord injuries. [4]
Diagnostic Procedures[edit | edit source]
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Outcome Measures[edit | edit source]
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Management / Interventions
[edit | edit source]
Progressive resistance strength training[5] : no evidence shows that strength training increases spasticity in patients with stroke. Musculoskeletal impairment are significantly reduced after resistance strength training.
Biofeedback combined with functional electrical stimulation and occupational therapy does not increase the degree of spasticity after treatment. It also showed a greater reduction in spasticity compared to patients who performed functional electrical stimulation and occupational therapy alone.[6]
Shock wave therapy on flexor hypertonic muscles of the forearm and interosseus muscles of the hand in patients with stroke showed significant reduction of muscle tone (>3months).[7]
Amelio reported significant reduction of muscle tone (>12 weeks) of plantar flexors in children with cerebral palsy.[8]
Significant reduction of ankle plantar flexor spasticity in patients with stroke after fifteen 10-minute sessions of continuous ultrasound therapy over a 5-week period (frequency 1MHz and intensity 1,5 W/cm2).[9][10]
Cryotherapy, using cold packs (12°C) for 20-minutes, can lower the muscle temperature to reduce the spasticity.[11]
Electric stimulation[12] : agonist stimulation showed a significant improvement in Ashworth scores. Antagonist stimulation showed an increase of stretch reflex-initiating angle.
Early treatment is important to avoid or reduce the severe complications due to this phenomenon.
Differential Diagnosis
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Key Evidence[edit | edit source]
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Resources
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Case Studies[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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- ↑ Lance JW. Symposium synopsis. In: Feldman RG,fckLRYoung RR, Koella WP (eds). Spasticity: DisorderedfckLRMotor Control. Chicago, IL: Year Book 1980:485–94.
- ↑ Pandyan AD, Gregoric M, Barnes MP et al. Spasticity: clinical perceptions, neurological realities and meaningful measurement. Disabil Rehabil 2005;27:2–6.
- ↑ 3.0 3.1 Lance JW. The control of muscle tone, reflexes, and movement: Robert Wartenberg Lecture. Neurology. 1980;30(12): 1303-13.
- ↑ Gracies JM, Bayle N, Vinti M, Alkandari S, Vu P, Loche CM, Colas C. Five-step clinical assessment in spastic paresis. Eur J Phys Rehabil Med. 2010 Sep;46(3):411-21.
- ↑ Morris SL, Dodd KJ, Morris ME. Outcomes of progressive resistance strength training following stroke: a systematic review. Clin Rehabil. 2004 Feb;18(1):27-39.
- ↑ Lourenção MI, Battistella LR, de Brito CM, Tsukimoto GR, Miyazaki MH. Effect of biofeedback accompanying occupational therapy and functional electrical stimulation in hemiplegic patients. Int J Rehabil Res. 2008 Mar;31(1):33-41
- ↑ Manganotti P, Amelio E. Long-term effect of shock wave therapy on upper limb hypertonia in patients affected by stroke. Stroke. 2005 Sep;36(9):1967-71. Epub 2005 Aug 18.
- ↑ Amelio E, Manganotti P.Effect of shock wave stimulation on hypertonic plantar flexor muscles in patients with cerebral palsy: a placebo-controlled study. J Rehabil Med. 2010 Apr;42(4):339-43.(B)
- ↑ Ansari NN, Adelmanesh F, Naghdi S, Tabtabaei A.The effect of physiotherapeutic ultrasound on muscle spasticity in patients with hemiplegia: a pilot study. Electromyogr Clin Neurophysiol. 2006 Jul-Aug;46(4):247-52.(B)
- ↑ Ansari NN, Naghdi S, Bagheri H, Ghassabi H. Therapeutic ultrasound in the treatment of ankle plantarflexor spasticity in a unilateral stroke population: a randomized, single-blind, placebo-controlled trial. Electromyogr Clin Neurophysiol. 2007 May-Jun;47(3):137-43. (B)
- ↑ Harlaar J, Ten Kate JJ, Prevo AJ, Vogelaar TW, Lankhorst GJ. The effect of cooling on muscle co-ordination in spasticity: assessment with the repetitive movement test. Disabil Rehabil. 2001 Jul 20;23(11):453-61.
- ↑ Van der Salm A, Veltink PH, Ijzerman MJ, Groothuis-Oudshoorn KC, Nene AV, Hermens HJ. Comparison of electric stimulation methods for reduction of triceps surae spasticity in spinal cord injury. Arch Phys Med Rehabil. 2006 Feb;87(2):222-8.
