Stroke And Spasticity

After a stroke, the nervous system attempts to “rewire” and repair itself to compensate for the lost motor control. In many cases, the nervous system is unable to restore normal control to all the muscles. Some muscles do not respond at all, while others are significantly overactive, resulting in dysfunctional postures of the shoulder, arm and hand and often leg and foot as well. These dysfunctional muscles at times hide muscles that may actually have good control.

The blocked messages between the brain and the muscles cause arm and leg muscles to cramp or spasm (spasticity) and not respond to your attempts to move as they should. Spasticity limits your coordination and muscle movement, making daily activities such as taking a shower, eating and dressing more difficult.

Spasticity can cause long periods of strong contractions in major muscle groups, which can even be quite painful. These spasms can produce:

1. A tight fist

2. Bent elbow

3. Arm pressed against the chest

4. Stiff knee

5. Inverted ankle and curled toes

If left untreated, spasticity can lead to shortened tendons and limbs that can no longer be straightened out. This can also lead to skin breakdown and pressure sores and will dramatically impair your potential to recover useful function in that limb. Contracture causes the muscles in the hand and wrist to tighten and shrink, which can lead to deformity of the joints and progressive loss of function over time. Spasticity is a disorder of [upper motor neurons] and is one of the common complications of a stroke or brain injury. It is also common following a spinal cord injury, multiple sclerosis, cerebral palsy and any other disorder that affects the central nervous system. Often, spasticity develops months or even a year after the injury — and often may become more noticeable during recovery.

Spasticity is a challenging problem, but there are solutions and ways to effectively control it or eliminate it entirely.

A year of rehabilitation is usually the first course of treatment before surgery or other treatments are considered. Treatment techniques our team uses to restore function include:

1. Botox injections

2. Partial cutting of an overactive nerve (neurotomy)

3. Transfer of nerves to exchange spastic function for good control in important muscle groups (nerve transfer)

4. Lengthening or cutting of tendons that are shortened and immobile

5. Rerouting of tendons to balance forces across a joint (tendon transfer)

6. Spinal cord stimulation is finding its place as an emerging treatment to reduce spasticity and improve function in patients with UMN injuries.

Our Paralysis Specialists work with you to develop the most effective plan for reducing spasticity and restoring function. In order to determine the best course of treatment for each individual case, we identify the activity present in each muscle and level of control in that particular muscle and how it responds to attempts to move it, attempts to move its antagonist, and attempts to passively move the joint. This information will help guide us in devising the best reconstructive strategy for removing the impediments to well controlled movement. This information is usually gathered from a detailed physical examination and EMG studies.

In order to predict the effectiveness of surgical treatment, local injections of Botox may be given prior to surgery. These injections are intended to mimic the effect of surgery by temporarily relaxing the problematic muscle(s).

Regularly stretching your tight muscles and exercising to develop better control of that limb can help control spasticity. Physical therapy and scheduled home exercise routines can be very helpful in reducing spasticity, but they are not always easy to do, especially at the beginning when you are trying to work your rigid muscles.