Many people who have a Spinal Cord Injury (SCI) often experience spasticity. Spasticity can be beneficial to function but when spasms are poorly controlled may lead to medical complications, impair function and decrease Quality of Life. The purpose of this chapter is to explain what causes spasticity, understand the benefits and drawbacks to spasticity, and understand how to manage spasticity.
What is spasticity?
- Spasticity, or spasms, are spontaneous, involuntary, uncoordinated reflex movements of muscles
- Any muscle group below your level of injury can be involved
It can be common to have:
- Increased muscle firmness (muscle tone)
- Hyper-excitability of stretch reflexes
- Uncontrolled, or involuntary muscle contraction
- Interference with movement
Spasticity may be felt as one long muscle contraction OR be jumping-like movements. Spasticity is different than stiffness: it is speed dependent, which means that the faster or slower you move can influence the amount of spasms that you may feel.
What causes spasticity?
Any stimulus or sensory input received below the level of spinal cord injury can trigger reflexes and excite muscles below that level of injury. Because the brain can no longer send a message down through the spinal cord to calm the reflex down, the body’s response to the stimulus is either a bending of the muscles (flexion) or a straightening of the muscles (extension).
WHAT DO I NEED TO KNOW?
What can increase your spasticity?
- Improper positioning
- Infections (i.e. UTI/bladder infection)
- Distention (bowel or bladder)
- Increased effort
- Anything that would be considered unpleasant/painful to the body such as: pressure sore, ingrown toenail, burn, etc.
- Some people report that changes in barometric pressure can affect spasticity
What are the benefits of spasticity?
- Signal that something may be wrong in your body
- Can maintain muscle tone (prevent muscle wasting)
- Improves blood circulation
- Intentionally triggered spasms can help with bowel and bladder function
- Can assist with various functional activities such as transfers, balance, walking
What are the drawbacks to spasticity?
- Causing joint contractures – permanent shortening in muscles around the joints that prevents full range of motion
- Poor posture or seating
- Sleep disruption/Fatigue
- Decreased abilities to transfer, change positions, balance
- Skin breakdown due to shearing
- Bowel and bladder accidents
DID YOU KNOW?
Common triggers for spasticity are bladder, bowel and skin.
WHAT CAN I DO?
How can spasticity be managed?
- Removal of stimulus: remember that spasticity can be a sign of something wrong, a problem you can’t feel.
2. Physical management:
Range of motion and stretching: Daily routine of range of motion and movement can prevent contractures & minimize spasticity.
- Slow, continuous stretching can slow down and relax the muscle reflex.
- Avoid a quick stretch as this will increase spasticity.
- Positioning well in your bed or chair is a better tool to maintain your flexibility than range of motion or stretching.
- Other physical ways to manage spasticity include:
3. Medication management
- Main medications: Baclofen, dantrolene, tizanidine, clonidine, gabapentin
- Other options: Marijuana, baclofen pump, injections (either botox or phenol)
- Every drug has side effects. Have a risk/benefit discussion with your physician.
DID YOU KNOW?
A daily routine of range of motion and movement can prevent contractures and minimize spasticity.
DID YOU KNOW?
Every drug has side effects: always discuss the risks and benefits with your doctor and team.
WHO CAN HELP ME?
Spasticity can be complex to treat and problem solve. A variety of spinal cord injury clinicians may be involved in your care.
Physiotherapists or physical therapists assess mobility, range and strength, as well using therapies for pain and spasticity. They play an important role in assisting clients to develop the techniques and strength for transfers, mobility and wheelchair skills. They also help with equipment selection.
For spasticity, a physiotherapist may help clients identify and prevent triggers or help clients identify alternative movement strategies that minimize the effect of spasticity on daily life. They may also assess the degree of spasticity and suggest splints, tools or exercises that can improve function.
Occupational Therapist (OT)
An OT helps clients develop strategies and techniques for activities of daily living (eating, grooming, dressing and bathing) after spinal cord injury. They assist with evaluating your home for accessibility and making recommendations for renovations and equipment needed to live safely. An OT does assessments for wheelchairs, seating and other equipment if needed.
For spasticity, an OT may assist with identifying splints, tools or strategies to minimize the effects of spasticity on everyday life or prevent long term consequences of spasticity (such as contractures or skin breakdown). OT services are available through GF Strong’s Spinal Cord Outpatient Program, and may also be available from your local health authority community health/home care services.
Physiatrist (Physical Medicine and Rehabilitation)
A physiatrist treats a wide variety of medical conditions affecting the brain, spinal cord, nerves, bones, joints, ligaments, muscles, and tendons. Physiatrists have a broad medical expertise on the whole body and can oversee a person’s medical care after a spinal cord injury.
Physiatrists will assess spasticity for its affects on other aspects of general wellbeing such as sleep, mobility, pain and daily life, and refer to other clinicians such as physiotherapists, occupational therapists. They will consider spasticity in the total picture of a person living with SCI, and recommend treatment options such as stretches, medication or surgical procedures.
A spine or neurosurgeon concentrates on injuries of the spinal cord and peripheral nerves, and may be able to offer surgical treatments for severe spasticity such as intrathecal baclofen or rhizotomy. You are usually referred to a surgeon after assessment of spasticity by a physiatrist.
Spasticity is an issue of management, as you will not be able to completely eliminate spasms. Don’t ignore a change in the intensity or pattern of your spasticity as it can interfere with function and quality of life. Educate yourself to find therapy strategies that optimize your function and quality of life.
- SCIRE Project: Spasticity – Research-based resource about spasticity by clinicians and researchers from UBC and GF Strong.