Diagnosis of spasticity
Diagnosis of suspected spasticity is mainly limited to physical examination. The tests mainly relate to the patient’s mobility and muscle tension (also called muscle tone). The examiner tests the tonus by asking the patient to relax his or her limbs completely.
The doctor then moves the joints passively, paying attention to the resistance that is opposing the movement. While the passive movement should be easy for a healthy person, the same movement is more difficult for a patient suffering from spasticity. The joint feels stiff in its mobility and the physician must apply real force to perform a passive movement.
If the spasticity is severe, even a layperson can see at a glance the cramped limbs that are being stretched or pressed against the body. This so-called tonus increase (or hypertonus of the musculature) is also reflected in increased reflexes. Since the extrapyramidal system with its inhibitory character is ineffective, there is a more violent muscle response to reflexes than in healthy people.
Primitive reflexes, so-called pyramidal trajectory signs, which are normally suppressed by the extrapyramidal system, can also be triggered. These primitive or early childhood reflexes can normally only be triggered in babies up to a certain age. Examples are the grasping reflex – when the palm of the hand is touched, the patient’s hand closes just like in babies – and the Babinski reflex as a classic sign of a disorder of the locomotor system. In the Babinski reflex, the big toe is raised by stroking the sole of the foot from the heel to the toes.
Symptoms of spasticity
The intensity of the symptoms in spasticity may vary from patient to patient. Depending on the degree of damage, more or less muscles are affected. The clinical picture ranges from hardly noticeable movement restrictions to complete physical disability.
A subdivision can be made by the location of the spastic paralysis. The following forms are usually observed: In addition to the restriction of limb mobility, other muscle-controlled processes can also be influenced. These include speech disorders (dysarthria) and swallowing disorders (dysphagia).
The patient is no longer able to express himself verbally because the muscles used to produce speech are restricted in their function. Such involvement means an enormous amount of suffering for those affected. The eye muscles can also be affected by paralysis.
Since the movement of the two eyes is no longer coordinated, double vision occurs. Further symptoms are the diagnostically used pyramidal path signs, as well as the increased muscle reflexes.In addition to the physical impairments, the patient may develop psychiatric symptoms. Since spasticity is the symptom of a serious illness, anxiety, aggression and depression may occur.
Occasionally, spastic paralysis causes pain due to extreme muscle tension, which should be treated to alleviate the suffering.
- Monospasticity: a limb is affected by spasticity;
- Paraspastic: both limbs of one body level, e.g. both legs, are spastically paralyzed;
- Hemispasticity: one half of the body is subject to spasticity;
- Tetraspasticity: all limbs are paralyzed, and variably the muscles of the chest and neck may also be affected.
Due to the excessive uncontrolled activation of the musculature, strong tension and cramps often occur. These can occur in different parts of the body and are often accompanied by severe pain.
If the skeletal musculature, i.e. the muscles that are needed for body movements, is affected, this can lead to an impairment of the joints. This is because spasticity often puts them in painful positions that cannot be released easily by the person affected. A spastic cough is a cramping of the airways, especially the bronchial tubes, which leads to a recurring spastic contraction of the lungs.
This leads to a severe cough in the affected person. An audible whistling and wheezing respiration is particularly noticeable. In most cases, the spastic cough is caused by an infection, which leads to pneumonia.
However, inhalation of a foreign body, i.e. aspiration, can also lead to spastic cramping of the airways. In the treatment of the latter cause, therefore, the first priority is to remove the foreign body from the lungs. In the case of an infection, it must be treated quickly, depending on the pathogen causing it.
In addition, cough-relieving medication should be taken. Spastic cerebral palsy is a form of paresis (i.e. muscle paralysis or slackening) caused by damage to the brain (= “cerebral”). The brain damage is often already present in the newborn due to malformations, a complication during birth, an infection during pregnancy or a brain hemorrhage.
The result is a variety of disorders of the muscles in the arms and legs, often accompanied by severe muscle weakness. This leads to excessively pronounced reflexes and insecurity in standing and walking. In the long term, this leads to a curvature of many joints and associated severe pain.
Spastic cerebral palsy can also lead to scoliosis. Furthermore, spastic cerebral palsy can be accompanied by other symptoms. These include a reduction in intelligence and abnormal behavior, such as uncontrolled sadness or anger. Therapeutic options include physiotherapy, various joint operations and Botox, for example.
