Spasticity is a motor disorder that can significantly impact a patient's quality of life. However, there are various ways to manage this symptom and limit the difficulties it can cause in daily life. In this article, we will explore the different origins of spasticity, its characteristic symptoms, and the techniques for managing and treating it. neurological rehabilitation used today in the treatment of this condition.
What is spasticity?
Spasticity is defined by reflexive, speed-dependent muscle contractions. These result in muscle stiffness upon stretching, generally affecting the muscles of the limbs with motor deficits. This condition is characterized by its significant variability over time: its symptoms, of varying intensity, can occur during the day as well as at night, and can thus significantly impact the quality of sleep for the affected individual.
This symptom of spasticity can be observed following certain pathologies affecting the pyramidal tract, such as multiple sclerosis, or as a consequence of a stroke. Furthermore, certain factors, also known as irritants (stress, fever, skin injuries (pressure sores), infections (urinary, dental)), can significantly impact a patient's level of spasticity.
The various consequences of spasticity
The main consequences of spasticity are muscle hypertonia and increased deep tendon reflexes. These various disorders can have significant repercussions for the patient, including:
- spasms;
- contractures;
- an abnormal physical posture;
- pain, etc.
The impact of spasticity on the quality of life of a patient suffering from this condition is therefore very real. Furthermore, spasticity can... generate motor disorders and a loss of dexterity in the fingers. These effects are likely to make everyday tasks increasingly difficult for a patient with spasticity, not to mention the psychological consequences and loss of self-esteem that these difficulties can also cause.
What can cause spasticity?
According to Dr. Laura Terrier, a neurosurgeon at the Charles Nicolle University Hospital in Rouen, spasticity can be caused by a nerve disorder related to the neurons in the stretch loop of voluntary muscles, or by a difficulty in transmitting information between the muscle and the nerve (nerve conduction deficiency). These types of problems can occur in various situations, including following:
- a stroke (CVA);
- an advanced form of multiple sclerosis;
- spinal cord injuries (trauma, tumor, etc.);
- cerebral palsy.
The different possible approaches to treating spasticity
To effectively treat spasticity, several approaches can be considered depending on the patient's condition and the severity of the pathology.
Drug treatments
Drug treatments play a vital role in managing spasticity, although their effectiveness can vary depending on the patient and the underlying causes. Here are the main medications used in the treatment of spasticity:
Benzodiazepines: Medications like diazepam can help reduce muscle tension due to their relaxing effects. However, prolonged use can lead to adverse effects in the patient, such as excessive drowsiness.
Baclofen: This muscle relaxant inhibits the activity of excitatory neurons in the spinal cord, thereby reducing muscle contractility. Intrathecal administration (into the lumbar region) is preferred in severe cases where oral treatments are ineffective.
Botulinum toxin (Botox): injected into muscles affected by spasticity, it reduces muscle contraction. It is ideal for treating localized spasticity, but requires repeated injections.
Dantrolene: this drug offers the possibility of directly reducing muscle contraction, but its use is limited by its potential side effects on the patient, particularly on the liver.
Ion channel modulators: drugs like tizandine modulate the release of excitatory neurotransmitters in the central nervous system. They are favored because of their less pronounced side effects.
Rehabilitation: a cornerstone of spasticity treatment
Rehabilitation plays a key role in the treatment of spasticity. For example, a physiotherapist can apply mobilization, stretching, and muscle strengthening techniques to improve joint mobility and reduce stiffness. These exercises are particularly important for maintaining muscle balance in the patient and preventing contractures.
Neurodynamics and nerve mobilization techniques can also help target spasticity foci by assisting the patient in working on neural structures to improve motor coordination. Adapted physical activities, such as walking, water aerobics, or using stationary bikes, can also help strengthen motor coordination and reduce spasticity.
| Our advice: adapting exercises to each patient is essential to achieving significant results. This process often requires close collaboration between physiotherapists, neurosurgeons, and physicians. |
Irritant thorns
Irritation spines are pathological foci located in the spinal cord. In some cases, they can play a significant role in worsening spasticity. These spines can cause exaggerated reflexes and involuntary muscle contractions in affected patients. Their management relies on early physiotherapy intervention, including mobilization and relaxation techniques to reduce muscle overactivation. In certain cases, manual approaches, such as neurodynamic techniques or electrical stimulation, can also be used to influence these reflexes, while improving muscle agility and posture.
Neurosurgery: a treatment for spasticity in severe cases
When spasticity does not respond to medication and rehabilitation, neurosurgery may be considered. Selective rhizotomy is a technique frequently used in such cases. It involves severing certain nerve roots responsible for muscle hyperactivity, particularly in cases of localized spasticity. This procedure can be performed under radiological guidance or via traditional open surgery.
| Good to know: Selective rhizotomy is primarily indicated for severe cases where spasticity significantly impairs the patient's muscle function. However, it requires a thorough patient evaluation to avoid any risk of complications. Other neurosurgical techniques, such as deep brain stimulation (DBS), are being studied for the treatment of spasticity and are showing promising results in complex neurological cases. |
The importance of rehabilitation in the management of spasticity
There are various rehabilitation techniques used in the treatment of spasticity. Although they are based on different concepts, they all aim to improve sensorimotor recovery and movement learning to enable the patient to regain optimal independence in their daily life.
Bobath's concept [1], for example, aims to inhibit, among other things, spasticity to improve voluntary limb movement. Postural control follows a progression that begins with the supine position and progresses to the walking stage.
Conversely, Brunnström's concept exercises tend to use spasticity to exploit the patient's abilities to enable them to stand and walk as quickly as possible.
Neurological rehabilitation can also play a central role in the management of spasticity. Regular muscle and tendon stretching, for example, can eliminate the symptoms of the condition in the short term and prevent certain long-term side effects.
Finally, it is important to note that electrical stimulation is not used systematically by rehabilitation teams in the management of spasticity. It does, however, allow for the management of the motor function of muscles antagonistic to spastic muscles and contributes to optimizing the contraction strength of weakened muscles. Nevertheless, electrical stimulation should in no way replace the various rehabilitation methods described previously.
The Allyane neuromotor reprogramming method in the context of spasticity treatment
The Allyane neuromotor reprogramming method offers a new approach in the context of spasticity managementThis is a complementary tool to the principles of rehabilitation, which allows for short- and medium-term clinical results.
Indeed, neuroscience has made it possible to highlight the impact of proprioceptive stimulation in the conception of a movement [2] [3] and that of mental imagery (in particular motor imagery) to maintain neuro-sensory affluences and motor performance by cortical training [4], [5], [6], [7].
Would you like to learn more about our rehabilitation method for treating spasticity? Don't hesitate to contact us:
FAQ
What is the difference between spasticity and rigidity?
Spasticity and rigidity are two motor disorders linked to lesions of the central nervous system. They differ in their origin and manifestations. Spasticity is characterized by increased muscle tone and the appearance of exaggerated reflexes. It is often triggered by rapid movement or exertion and is related to dysfunction of the motor nerve pathways. Rigidity, on the other hand, manifests as uniform muscle resistance during movement, regardless of its speed, and is generally associated with neurological conditions, such as Parkinson's disease.
When does spasticity occur?
Spasticity usually occurs after an injury to the central nervous system, affecting the motor pathways responsible for regulating muscle tone. It is often observed following neurological conditions, such as stroke (stroke), spinal cord injuries, multiple sclerosis, traumatic brain injury, or neurodegenerative diseases (such as cerebral palsy). Spasticity can develop gradually, often after a period of post-accident recovery, and manifests as muscle stiffness and involuntary contractions.
What increases spasticity?
Several factors can increase spasticity, making it more difficult to control. These include:
- urinary tract infections, lung infections or any other infection;
- pain, whether it originates from muscles, joints, or is related to other conditions;
- Changes in temperature: extreme temperatures, especially cold, can lead to increased muscle stiffness, while excessive heat can sometimes induce muscle hyperactivity;
- Certain hormonal or metabolic imbalances, such as electrolyte disorders, can increase spasticity;
- Prolonged poor posture or sudden movements can trigger or worsen spasticity;
- A person's emotional state plays a key role, and stress can amplify the symptoms of spasticity;
- Lack of movement and muscle stimulation can also lead to a loss of flexibility and an increase in muscle stiffness.
These factors must be carefully managed to prevent spasticity attacks and optimize patient care.
[2] Formento E, Minassian K, Wagner F, Mignardot JB, Le Goff-Mignardot CG, Rowald A, Jocelyne Bloch J, Micera S, Capogrosso M, Courtine G. Electrical spinal cord stimulation must preserve proprioception to enable locomotion in humans with spinal cord injury. Nature neuroscience Oct 2018
[3] Avanzino L, Bassolino M, Pozzo T, Bove M. Use-dependent hemispheric balance, J Neurosci, 2011, vol. 31 (pgs. 3423-3428)
[4] Oostra KM, Oomen A, Vanderstraeten G, Vingerhoets G. Influence of motor imagery training on gait rehabilitation in sub-acute stroke: A randomized controlled trial. J Rehabil Med. 2015 Mar;47(3):204-9. doi:10.2340/16501977-1908
[5] Mateo S, Di Rienzo F, Bergeron V, Guillot A, Collet C, Rode G. Motor imagery reinforces brain compensation of reach-to-grasp movement after cervical spinal cord injury.Front Behav Neurosci. 2015 Sep 11;9:234. doi: 10.3389/fnbeh.2015.00234. eCollection 2015. Review
[6] Ehrsson H., Geyer S., Naito E. – Imagery of voluntary movements of fingers, toes and tongue actvates corresponding body-part specific motor representations – Journal of Neurophysiology, n°90, 2003, pp.3304-3316
[7] Rulleau T, Toussaint L. Motor imagery in rehabilitation. Kinesither Rev. Apr 2014
