Managing Spasticity: Insights from One of Hamilton’s Leading Physiotherapists

Celine Dion had been in the news  and not because of her beautiful voice.  In December 2022 Celine revealed that she had been diagnosed with a rare condition known as Stiff-person syndrome (SPS).  SPS is a neurological condition that is not well known and if often mistaken for other disorders before it is diagnosed.  SPS causes painful muscle contractions and spasms and unfortunately it is a progressive condition.  Celine Dion’s diagnosis has placed these issues in the spotlight and one of these issues is spasticity.  Spasticity is common in cases such as SPS but is also often experienced following a stroke, brain injury or spinal cord injury.

WHAT IS SPASTICITY?

Spasticity is caused when signals from the brain and spinal cord that control the muscles are damaged or disrupted.  This is the result of conditions such as cerebral palsy, multiple sclerosis, Parkinson’s disease, stroke, brain injury and spinal cord injury.  Spasticity is triggered when the person, or caregiver,  tries to move or stretch the affected limbs.  The muscles resist being fully stretched and remain rigid or stiff.  This may also be referred to as increased muscle tone, and ranges in severity from mild stiffness or tightening of muscles to painful spasms.  If muscles remain contracted, the surrounding tendons and soft tissue will shorten which impacts mobility, speech and leads to other challenging conditions.

Spasticity may be difficult to diagnose.  A physical examination with a physician will need to be conducted and an MRI may be ordered to discover the source of spasticity and the extent of damage it has caused.

WHAT ARE COMPLICATIONS OF SPASTICITY?

●       Pressure sores – when muscles can not fully stretch, and remain in a bent position, there is the risk that pressure sores will develop.  

●       Fatigue

●       Muscle and joint deformities

●       ‘Frozen joints’

●       Uncontrollable and painful muscle spasms – often affecting sleep

●       Muscle stiffness

WHAT CAN TRIGGER OR INFLUENCE SPASTICITY:

●       Sudden changes in temperature can temporarily worsen the symptoms of spasticity

●       Urinary Tract Infections (UTIs), constipation, ingrown toenail  and other skin issues can increase spasticity

●       Stress can aggravate symptoms of spasticity as the affected person is unable to dedicate the same level of concentration to relax spastic muscles.

●       Tight clothing, splints rubbing against an arm or leg or new footwear rubbing against the skin can impact circulation

●       Fatigue can impact stress levels and influence spasticity

HOW IS SPASTICITY TREATED?

NON-SURGICAL TREATMENTS:

Non-surgical treatment includes physiotherapy, occupational therapy and speech therapy.

A physiotherapist will focus on stretching and strengthening exercises to improve range of motion and mobility.  They may be involved in casting or bracing to assist in the prevention of involuntary spasms and to reduce the tightness of the muscles.  They may also use various modalities and weight bearing to manage tone.

An occupational therapist may focus on smaller muscle groups to improve strength and coordination necessary to complete daily activities.

A speech therapist can assist people who have had their speech impacted by spasticity.

Oral medications may be used in conjunction with adjunctive therapies if symptoms are interfering with daily function and sleep.

BOTULINUM TOXIN INJECTIONS (BOTOX):

Botox may be recommended by a physician or physiatrist.  Botox injections are designed to target and temporarily paralyze spastic muscles.  Botox is injected into selected areas depending on the pattern of the spasticity. The impact of Botox may not be felt for several days following injection and it is not a permanent solution as the effects only last up to three months.  It is important to be aware that there may be side effects from Botox injections.  Your doctor will discuss this with you.  Botox injections can be quite effective in combination with adjunctive therapies supported by allied health professionals.

SURGERY:

Intrathecal Baclofen Pump (ITB): a pump is surgically placed into a patient’s stomach and releases a steady dose of baclofen directly to the spinal fluid.  This reduces spasticity and pain but will only be considered in extreme cases.

Selective Dorsal Rhizotomy (SDR): SDR rebalances the signals sent to the spinal cord by cutting selective nerve roots.  This is done in severe cases of spasticity in the legs. It is most commonly used in patients who have cerebral palsy. 

Spasticity can be complicated to treat but with close communication with doctors and therapists, it can be managed to prevent issues as much as possible.  It is important to keep on top of it as spasticity can affect all areas of a person’s life and also impact the type and level of care an affected person requires.   It can also affect a person’s ability to be seated well in a wheelchair. 

For more information or to discuss your spasticity needs- contact our physiotherapist at HNHB Spine and Neuro Rehab.