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.
| The main thing to remember La spasticity is an involuntary muscle stiffness linked to an injury to the central nervous system (stroke, multiple sclerosis, spinal cord injury, cerebral palsy). It varies over time and can be aggravated by “irritating thorns(infection, pain, stress, cold). His support Treatment is multidisciplinary: medication, physiotherapy, neuromotor rehabilitation, and surgery (in the most severe cases).neuromotor programming Allyane acts on voluntary motor control and complements conventional rehabilitation in a non-invasive way. |
Definition of spasticity
La spasticity is defined by reflexive and speed-dependent muscle contractions. These result in a muscle stiffness to stretching, generally affecting the muscles of the limbs with motor deficits. This condition is characterized by its great capacity for variation over time: its symptoms, of varying intensity, can occur during the day, but also at night, and can thus significantly impact the quality of sleep of the affected person. This symptom of spasticity can be found in the course of certain pathologies affecting the pyramidal way, as the multiple sclerosis or as part of the after-effects of a stroke (AVC).
More broadly, the spasticity is a frequent complication of damage to the central nervous system : it would affect nearly 80% of people with multiple sclerosisApproximately 80% of spinal cord injury patients, and 70 to 80% of children with spinal cord injuries cerebral palsy and nearly 30% of patients after a stroke. Furthermore, certain factors also known asirritating thorns (stress, fever, skin injuries (bedsores), infections (urinary, dental)) can have a significant impact on the level of spasticity of a patient.
The various consequences of spasticity
The main consequences of the spasticity are themuscle hypertonia and increased deep tendon reflexes. These various disorders can have significant repercussions for the patient, including:
- some spasms ;
- some contractions ;
- an abnormal physical posture;
- pain, etc.
The impact of spasticity The impact on the quality of life of a patient suffering from this condition is therefore very real. Furthermore, it can lead to motor disorders and a loss of dexterity in the fingers. These effects are likely to make everyday tasks increasingly difficult for a patient with this condition. spasticity, not forgetting the psychological consequences and loss of self-esteem that these difficulties can also cause.
Where does spasticity manifest itself?
La spasticity can affect the upper limb such as inferior memberThe most frequently affected areas are the elbow (in approximately 79% of patients), the wrist, and the ankle (approximately 66% each). Other joints may be affected: the shoulder, hand, knee, foot, or hip. At the level of the legs, the spasticity This often results in a bending of the knee or hip, an equinus foot, or a clubfoot. spastic ; at the level of upper limbs, by bending the elbow or wrist, making a clenched fist, or internally rotating the shoulder.
At the level of the lower limbs (weight-bearing limb), the muscles most often affected are those of the extension chain: triceps sural, quadriceps and adductors. The repercussions appear mainly in walking: slowness, instability, "robotic" gait, difficulty putting the foot on the ground, or even impossibility of standing.
At the level of the upper limbs, The muscles involved are those of the flexion chain: pectoralis major, biceps brachii, brachialis, wrist and finger flexors, pronators, and thumb adductor. The consequences are significant in daily life: limited or no hand function, limb curled inward, and difficulty with eating, washing, or dressing.
| Note : the spasticity is not always harmful. After a stroke, it can be the first sign of the return of motor function, and a hypertonia du quadriceps It can, for example, allow for knee locking that is useful for standing. That's why we only try to reduce it when it becomes bothersome. |
How is spasticity diagnosed?
The diagnosis of spasticity is based on a clinical examination performed by a specialist physician, most often a physical medicine and rehabilitation (PM&R) physician or a neurologist. The evaluation takes place in two stages: identification of the cause (stroke, multiple sclerosis, spinal cord injury, cerebral palsy…), then measuring the intensity of the disorder.
The practitioner assesses the limb's resistance to passive movement and looks for exaggeration of the stretch reflex. The spasticity is a hypertonia said to be "elastic" and speed-dependent: like a spring, muscle resistance increases with the speed of stretching. It can be quantified at the patient's bedside using clinical reference scales such as theAshworth scale (modified), the scale of Hero or that of TardieuThis measure is essential because it determines the objectives of the treatment: a spasticity is not systematically addressed, only one spasticity genuinely bothersome on a daily basis justifies active management, defined with the patient.
What can cause spasticity?
According to Dr. Laura Terrier, neurosurgeon at the Charles Nicolle University Hospital in Rouen, the spasticity This can be caused by a nerve disorder related to the neurons of the stretch loop in 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 as a result of:
- un stroke (stroke);
- an evolved form of multiple sclerosis ;
- lesions of the spinal cord (trauma, tumor, etc.);
- another cerebral palsy.
The different possible approaches to treating spasticity
To effectively treat the spasticitySeveral approaches can be considered depending on the patient's condition and the severity of the pathology. Treatment is always multidisciplinary and personalized: it combines, to varying degrees, physiotherapy, re-education neuromotor drug treatments, orthotics and, in the most severe cases, surgery. The first step systematically consists of looking for and treating any possible irritating spine aggravating.
Drug treatments
The drug treatments play a vital role in the management of the spasticityAlthough their effectiveness may vary depending on the patient and the underlying causes, the table below summarizes the main medications used:
Rehabilitation: a cornerstone of spasticity treatment
La re-education plays a key role in the treatment of spasticity. The physiotherapist For example, mobilization, stretching, and muscle strengthening techniques can be applied to improve joint mobility and reduce stiffness. These exercises are particularly important for maintaining muscle balance in the patient and preventing... contractions.
Neurodynamics and nerve mobilization techniques can also help target the foci of spasticity by helping the patient work on the nerve structures to improve their motor coordination. Adapted physical activities, such as walking, water aerobics, or using stationary bikes, can also help strengthen motor coordination and reduce the spasticity.
| Note : the application of cold (cryotherapy) is also a simple and frequently recommended way to temporarily reduce the spasticity, particularly in patients with multiple sclerosis. |
Neurosurgery: a treatment for spasticity in severe cases
When the spasticity does not respond to drug treatments and rehabilitative, the neurosurgery can then be considered. The rhizotomy Selective anesthesia is a technique regularly used in this situation. It involves cutting certain nerve roots responsible for muscle hyperactivity, particularly in cases of spasticity localized. This procedure can be performed under radiological guidance or via traditional surgical approach.
Bobath's concept, for example, tends to inhibit, among other things, the spasticity to improve voluntary limb movement. Postural control follows a progression that begins with the supine position, until reaching the walking stage.
Conversely, Brunnström's concept exercises tend to use the spasticity to utilize the patient's abilities to enable them to stand and walk as quickly as possible.
Allyane Therapy in the context of spasticity treatment
The method of neuromotor reprogramming Allyane offers a new approach to the management of spasticityThis is a tool that complements the principles of re-education, which allows for short- and medium-term clinical results.
Indeed, neuroscience has shed light on the impact of proprioceptive stimulation on the conception of movement and that of themental imagery (especially of themotor imagery) to maintain neuro-sensory affluences and motor performance through cortical training.
In practice, Allyane therapy combines listening to low-frequency sounds with a work ofmotor imagery in order to reactivate the areas of the primary motor cortex involved in controlling movement. By relying on the mechanisms of neuroplasticityIt aims to overcome motor inhibitions and restore a higher quality of voluntary motor pattern, whereas conventional approaches primarily focus on passively reducing muscle tone. This non-invasive and painless approach complements, but does not replace, physiotherapy and medical treatment.
This logic of restoring the neuromuscular control is at the heart of the care offered by Allyane, also available for central neurological conditions and orthopedic pathologies (knee, ankle, shoulder).
Clinical results observed
On the spasticity du triceps suralThe Allyane method resulted in an average decrease of 1,41 points in the score.Ashworth, obtained in 91% of treated patients and maintained at one month in 70% of them (work presented by A.-L. Chatain, ESO-WSO 2020, e-JNLF 2020 and SFNV 2019).
Would you like to learn more about our method of re-education in the context of the processing of the spasticity Don't hesitate to contact us.
FAQ
What is the difference between spasticity and rigidity?
La spasticity and rigidity are two of the motor disorders linked to lesions of the central nervous systemThey differ in their origin and manifestations. spasticity is characterized by an increase in muscle tone and the appearance of exaggerated reflexes. It is often triggered by rapid movement or exertion and is linked to a dysfunction of the motor nerve pathways. Rigidity, on the other hand, manifests itself as a uniform resistance of the muscle during movement, regardless of its speed, and is generally associated with neurological pathologies, such as Parkinson's disease.
When does spasticity occur?
La spasticity usually occurs after an injury to the central nervous systemaffecting the motor pathways responsible for regulating the muscle toneIt is often observed following neurological conditions, such as strokes (cerebrovascular accidents)spinal cord injuries, the multiple sclerosistraumatic brain injuries or neurodegenerative diseases (such as cerebral palsy). The spasticity can develop gradually, often after a period of post-accident recovery, and manifests itself through a muscle stiffness and involuntary contractions.
What increases spasticity?
Several factors can increase the spasticity and make it more difficult to control. Among the main ones:
- infections (urinary, pulmonary or other);
- pain, whether muscular, joint or of another origin;
- temperature changes, especially cold;
- certain hormonal or metabolic imbalances (electrolytic disorders);
- prolonged poor posture or sudden movements;
- stress and emotional state;
- the lack of movement and muscle stimulation.
These factors must be carefully managed to prevent crises. spasticity and optimize patient care.
Can spasticity disappear or be cured?
La spasticity results from a permanent injury to the central nervous system It therefore does not "disappear" spontaneously. However, its manifestations and impact can be significantly reduced through appropriate treatment. The goal is not to eliminate it at all costs—a spasticity If not bothersome, it does not need to be treated — but rather to limit the discomfort and prevent complications (contractions, deformities) and promote motor recovery.
Spasticity and multiple sclerosis: what to do?
La spasticity is one of the most frequent symptoms of the multiple sclerosisIts management involves re-education (stretching, physiotherapy, self-re-education), application of cold and, if necessary, drug treatments adapted to diffuse or localized nature. A sudden increase in spasticity must search for a irritating spine (urinary tract infection, wound, constipation…) first and foremost. The neuromotor reprogramming can complement this care by acting on the Voluntary motor control.
Is spasticity painful?
Yes, it can be. When a muscle remains contracted for too long or too intensely, it can become painful, and the spasms These are often described as cramps. However, the pain is not always present and its intensity varies greatly from person to person depending on the extent and location of the lesions.
Bibliography
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