Prognosis | Spasticity after stroke – therapy

Prognosis

The prognosis of spasticity after a stroke is highly variable and can be difficult to generalize. In general, spasticity does not develop until a few weeks after the initial flaccid paralysis. As long as the paralysis persists, an improvement in symptoms may be expected, and sometimes some activity may be regained.

If spasticity develops, the chances of improvement are worse. Whether spasticity will return cannot be predicted. The longer it lasts, the less likely it is to return.

History

After a stroke, there is reduced blood flow (ischemia) in the brain, and bleeding (hemorrhaging) can also cause stroke symptoms. This circulatory disorder can destroy brain tissue. Our capricious motor activity is also controlled cerebrally.

If disturbances occur in the area of these areas (precentral gyrus) or in the course of the corresponding pathways (e.g. internal capsule), the voluntary motor function can fail. This results in a flaccid paralysis, the patient can no longer move his or her extremity. There are other centers in the brain that are responsible for the regulation of muscle tone.

If these pathways (extrapyramidal pathways) also fail, the spinal control circuits for the muscles, i.e. those controlled by the spinal cord, become independent. When cerebral stimuli are absent, the muscles are activated in their own control loop, which is located at the spinal cord level. The tone is increased more and more.

This leads to spasticity. The transition from flaccid paralysis to spasticity usually takes a few weeks. You can find out more about the course and life expectancy here: “Stroke consequences”

Spasticity in the legs

Spasticity in the legs is perceived as particularly unpleasant. Nevertheless, walking with spasticity can be learned more compensatory than with flaccid paralysis. Due to the spasticity, the leg is usually stretched out, the foot turned inwards, the entire hip rotates slightly inwards.

When walking, the foot cannot be lifted sufficiently and the patient compensates by lifting the hip (Wernicke gait pattern). The basic principles for exercising a leg with spastic paralysis are the same as mentioned above. Lying down is particularly good for practicing to relieve spasticity, but sitting is also a good option.

Functional training for dealing with spasticity in everyday life should be performed in the required position. In addition to an exercise program, there are a variety of aids that can help you deal with leg spasticity in everyday life. Medical supply stores and health insurance companies can provide interesting information.

These articles may also be of interest to you:

  • At the beginning, the legs, if possible, can be gently rotated from side to side – “leg pendulum” – to generate a tonus regulation.
  • Afterwards, loading exercises can be done to create pressure in the joints of the leg. For this purpose, both legs are positioned if possible and the buttocks are lifted slightly from the support. A therapist can fix the affected leg.
  • When standing, weight can be shifted to the affected leg.
  • Physiotherapy gait training
  • Exercises for gait disorders