The term spasticity or spasticity comes from the Greek and means something like “cramp”. Accordingly, spasticity is a hardening and stiffening of muscles, causing movements to become uncontrollable.
What is spasticity?
Spasticity or spasticity is not a disease in its own right, but a symptom of a disease or injury to the central nervous system. Damage to the brain or spinal cord always plays a role. The voluntary movements of the body are coordinated by the central nervous system; if there is an injury here, the signal transmission from the nerves to the muscles is impaired. The result is uncoordinated muscle contraction, leading to stiffness and stiffness. These muscle contractions naturally result in uncomfortable pain. However, not all spasticity is equally pronounced in sufferers. Some people have only limited range of motion, while others are completely physically disabled by spasticity. So the pattern of spastic paralysis looks different in each patient.
Causes
Many different diseases or injuries can be responsible for spasticity. The cause of this symptom is damage to the descending nerve connections from the brain to the spinal cord (pyramidal tract). However, there is always also damage to the unconscious part of the nervous system, the so-called extrapyramidal motor system. As a result, calming signals to the muscle are prevented, which disrupts the regulation of the patient’s own reflexes. The result is painful muscle spasms. One of the most common causes of spasticity is a stroke, which destroys motor brain regions. In addition, cerebral hemorrhage, tumors in the spinal cord or brain, injuries or inflammation of the central nervous system, multiple sclerosis, brain damage in children (usually already caused by lack of oxygen at birth), and neurodegenerative diseases can trigger spasticity.
Symptoms, complaints, and signs
Spasticity manifests itself very individually. At its best, it can exist only in a very mild form and cause no significant limitations. At the other end are severe symptoms that result in serious physical disability. In principle, spasticity can affect any muscle. In this case, flaccid paralysis often occurs before spastic paralysis. Furthermore, four forms of spasticity are distinguished, each showing different symptoms. Paralysis of one limb represents monospasticity; paralysis of both legs represents paraspasticity; paralysis of one side of the body represents hemispasticity; paralysis of all limbs represents tetraspasticity. The latter may also be accompanied by paralysis of the trunk or neck. Other symptoms that occur with spasticity include paralysis of the eyes or larynx. There may then be corresponding strabismus, speech and swallowing problems, and slowed gaze and speech reflexes. Reflexes in spastic individuals are often expansive, follow false-seeming movement patterns, or are delayed. At times, involuntary movements occur. Eye-hand coordination may be severely impaired. Movements are sometimes very difficult to perform by the affected person. Spasticity may be associated with pain. In the case of congenital spasticity, the early childhood reflexes are also retained. Affected persons thus retain the palmar reflex, for example.
Diagnosis and course
A detailed clinical neurologic examination is necessary for the diagnosis of spasticity. This first focuses on an accurate analysis of the causative neurologic disease. Since spasticity often does not crystallize until several weeks or months after nerve damage, incidents from the more distant past must also be included in the assessment of findings. These can be spinal surgeries, infections, strokes or nerve-damaging accidents. Spasticity can affect a wide variety of body regions. In general, a distinction is made between monospasticity (the spasticity of a single extremity), tetraspasticity (the spastic paralysis of all extremities), hemispasticity (the spasticity of one half of the body) and paraspasticity (the spastic paralysis of the legs).The eye, swallowing, and speech muscles may also be affected by spasticity, leading to further limitations in the patient.
Complications
Spasticity has a very negative impact on the life and daily routine of the affected person. However, the further course depends very much on the exact degree of spasticity, so a universal prognosis cannot usually be given. However, the patients suffer from various paralyses or disturbances of sensibility. Swallowing difficulties may also occur, so that ordinary ingestion of food and liquids is not readily possible for patients. The reflexes and movements of the muscles are also significantly slowed down and muscle atrophy occurs. Especially in children, spasticity can also lead to teasing or bullying, causing psychological discomfort or depression. Those affected often suffer from involuntary movements and twitching. Disturbances in coordination and cramps in the muscles can also occur and make the daily life of the affected person much more difficult. Unfortunately, a causal treatment of spasticity is not possible. Sufferers are dependent on various therapies to make everyday life easier. Life expectancy is usually not reduced by spasticity. However, unfortunately, a completely positive course of the disease cannot be achieved.
When should you see a doctor?
A doctor must be consulted if spasticity is present. There can be no self-healing in this disease, so the affected person is always dependent on medical treatment. In most cases, spasticity cannot be completely cured, but the symptoms can be alleviated, so that the patient’s everyday life is also made easier. A doctor should be consulted if the affected person suffers from involuntary twitching in the muscles. Paralysis of muscles can also indicate spasticity and should be examined by a doctor. Many affected persons are also unable to speak or swallow properly, so that the intake of food and liquids is also significantly impeded by the spasticity. If these symptoms occur, a doctor must be consulted immediately. The sooner the doctor is consulted, the better the further course of the disease usually is. Spasticity can be detected by a pediatrician or by a general practitioner. However, further treatment depends very much on the severity and type of spasticity and is then carried out by a specialist.
Treatment and therapy
Complete cure of spasticity is not possible, but the individual signs of the disease can be treated symptomatically. Since it is a complex clinical picture, it is advantageous to carry out the treatment of spasticity with the involvement of physicians from different specialties. Each patient receives a therapy plan individually tailored to his or her symptoms. The most important thing here is to achieve an approximate restoration of the motor skills lost as a result of the spasticity. Since our brain is able to retrain such things, a functional restoration can be achieved, for example, through occupational therapy, physiotherapy or similar measures. Through movement therapy, the affected muscle parts should be specifically trained, which can be achieved, for example, through training on certain therapy devices. In some cases, certain movement exercises are also supported by the use of splints or plaster casts. Therapeutic horseback riding is also a suitable means of counteracting spasticity. Of course, there are also various drug treatments that are used for spastic paralysis. One proven remedy here is botulinum toxin, which is administered by injection into the affected muscle. Oral medications are also used to relieve muscle spasm and inhibit neuromuscular transmission of stimuli in spasticity. However, in this case, the undesirable side effects are often greater than the hoped-for effect in controlling spasticity.
Prevention
Preventive measures to prevent the expansion of spasticity include surgical interventions to anticipate deformity or to counteract worsening of spastic movement patterns. These include, for example, tendon lengthening, bone realignment, or muscle transposition.
Aftercare
The extent to which follow-up care is necessary depends on the symptoms of spasticity. Basically, two extremes can be distinguished: Some affected individuals remain in a spastic state for the rest of their lives, while others are able to participate in their usual daily lives if signs remain. Thus, aftercare has the functions of everyday support and long-term treatment. Exercise therapy has been particularly effective in alleviating symptoms. Patients have sessions with a therapist prescribed by their attending physician. The intensity of the exercises depends on the individual level of discomfort. In addition, they use suitable aids in their daily lives that enable them to remain as independent as possible. Wheelchairs, walkers and corsets are often used. There is also a range of antispastic medications. A doctor prescribes suitable remedies and regularly adjusts them to the clinical picture. Sometimes the question of how surgery can contribute to an improvement of the symptoms also plays a role in the aftercare. This can prevent deformities, for example. Spasticity can affect every area of life. Starting from the living situation up to the occupation, restrictions and effects are given. This puts a strain on the psyche, especially in adults. Therapy leads to stabilization.
What you can do yourself
If cramps occur, it is basically from the affected person but also from the persons present if possible to keep calm. Additional stressors or hectic movements are to be refrained from. They further worsen the general state of health and in no way help to improve the situation. It is important to know and use first aid measures so that life-saving actions can be taken in emergency situations. Spasticity is indicative of an underlying disease present. It is a symptom and not a disease in its own right. Therefore, the cause of the symptoms must be determined in cooperation with a physician. The further possibilities of self-help depend on the underlying disease. They are therefore individual and must be examined in each case. What they all have in common is the use of exercise therapy. This can be used by the patient on his or her own responsibility, according to his or her possibilities, even outside of therapy. Targeted training and exercise units to improve mobility help to cope with the underlying disease and can reduce the occurrence of spasticity. Mobility exercises should be performed daily so that relief from symptoms occurs and well-being is improved. In addition, a stable social environment is helpful in managing the underlying condition.
