What is tetra spasticity? | Spasticity

What is tetra spasticity?

Tetraspacification is a spasticity that is present in both arms and both legs, i.e. all four extremities. The cause is damage to the so-called pyramidal tract. This is a nerve cord that carries information and commands about movements from the brain via the spinal cord to the muscles.

If the pyramidal tract is damaged, the transmission of commands for the execution of a movement is also disturbed. Since all extremities are affected in tetra spasticity, the location of the damage is above the exit of the nerves for the arm muscles. Possible damage is located at the level of the spinal cord in the neck area or at the level of the brain stem (an area of the brain that connects above the spinal cord and through which the pyramidal tract passes). Damage to the pyramidal tract leads to an increase in the so-called muscle reflexes, i.e. the reflexes that are triggered, for example, by the biceps muscle and are also visible in the biceps muscle through a twitch. In addition, there is an increased counter-tension of the musculature if an attempt is made to move it passively, i.e. without the help of the person concerned.

Therapy of spasticity

When treating or resolving spasticity, it should be clear from the outset that no absolute cure can be expected.The various measures can only reduce the complaints, but this usually results in enormous relief for the patients. Mobility can be improved and pain in muscles or joints alleviated by various techniques of physiotherapy and other movement concepts (Bobath, water therapy, therapeutic riding). The use of medication can also be considered for support.

There is no recipe for success in the treatment of spastic paralysis, but an interaction of different disciplines is desirable. Each patient should receive his or her own individually tailored treatment program, since spasticity is an extremely changeable clinical picture, especially in varying degrees. Most of the exercises designed to improve movement in existing spastic paralysis or to relieve spasticity originate in physiotherapy (physiotherapy).

In physiotherapy, for example, affected limbs are moved passively by the therapist to maintain their mobility. Exercises performed by the patient are mainly aimed at building strength – not only the spastic muscles are trained, but also the healthy muscle groups. By building up muscles in their entirety, movements against spastic muscle tension become possible.

An important aid here is water therapy. In water, many movements can be performed without much muscle power. In addition, swimming strengthens the back, arm and leg muscles.

Another exercise in the broadest sense is therapeutic riding. Here, the patient suffering from spasticity rides a horse, which, however, should have special characteristics (not too big; not too much temperament). Through the muscle relaxing warmth of the horse and the natural movement while riding, which is similar to the movement while walking, the movement patterns can be (re-)learned, the sense of balance can be trained and the muscles can be strained.

The Bobath concept is a concept for rehabilitation (restoration of abilities as before the disease) of patients with central paralysis (in the brain or spinal cord). It is based on the assumption that the nervous system has the ability to transfer the functions of damaged areas of the brain to healthy areas and thus to restore physical functions. Within the framework of this Bobath concept, the limbs or half of the body affected by spasticity are particularly encouraged and integrated into the daily routine.

The brain is thus confronted with the stimuli generated by the paralyzed parts of the body. Both sensitivity and movement are trained on a daily basis and incorporated into every movement sequence, so that the affected limbs are constantly challenged. For example, a patient with hemiplegia should not lie in bed, but should sit at a table in a natural position if possible, when the situation is appropriate.

Overall, the Bobath concept is designed to reduce spasticity, increase the sense of position of the affected limbs (proprioception), relieve pain and return quality of life to the patient with as normal a daily routine as possible. Since the concept is extremely complex, especially in the beginning, it requires close cooperation between the patient, caregiver and relatives. The drug therapy of spastic paralysis is complicated.

Although there are various spasmolytic (spasmic relief) drugs that work by reducing muscle tone, they affect all the muscles of the body. As a result, the patient’s entire musculature relaxes. Overdose can also cause severe side effects such as respiratory arrest, which negatively affects the ratio of side effects to benefits.

Another possibility is the use of botulinum toxin, the Botox known from cosmetic surgery. Botox is a nerve toxin, which is used here in a highly diluted form. The nerve is immobilized by an injection, which prevents the transmission of stimuli and causes the spastically cramped muscle groups to relax.

In the so-called intrathecal baclofen therapy, the drug baclofen is continuously injected into the spinal canal (the water in the nerve) via a drug pump. Baclofen is a muscle relaxing drug (muscle relaxant) and in this dosage form is the most powerful form of drug treatment.It is only used in severe cases of spastic paralysis, for example in MS (multiple sclerosis). Botox® is one of many therapeutic options for treating spasticity.

Various quantities can be injected intramuscularly, i.e. directly into the muscles, using a syringe. Botulinum toxin (Botox® is short for botulinum toxin A) is used to treat spasticity. It inhibits the release of acetylcholine.

Acetylcholine is a neurotransmitter, i.e. a substance that mediates the transmission of information between nerve cells. If this is missing, spasticity is reduced. Magnesium can be effective in a mild form of spasticity.

Magnesium is the antagonist of the electrolyte calcium, which is necessary for the contraction of a muscle. Accordingly, magnesium leads to the relaxation of a muscle. Therefore, a simple tablet of magnesium dissolved in water often helps with mild spasms, which occur in the calves after exercise, for example.

This balances the electrolyte balance in the body and brings the magnesium and calcium balance into harmony. It should be noted, however, that magnesium only supports spasticity and cannot heal it. Unfortunately, spasticity cannot be completely cured in most cases.

However, the symptoms can be significantly reduced if the disease is detected early and adequate therapy is provided. It is important, for example, to continuously perform exercise therapy, i.e. physiotherapy or occupational therapy, to prevent the progression of muscle twitches and spasms and thus reduce spasticity.