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Muscle Spasticity


Presentation

  • Patients often present with associated pressure ulcers, deformed toenails, shoe or brace fitting challenges, and pain with ambulation or transfers.[ncbi.nlm.nih.gov]
  • Is it always present? How severe is it? Which muscles are affected? What makes it better? What makes it worse? What other symptoms are present? After determining the cause of your spasticity, the doctor may refer you to a physical therapist.[nlm.nih.gov]
  • Although spasticity is part of the upper motor neuron syndrome, it is frequently tied to the other presentations of the said syndrome.[ncbi.nlm.nih.gov]
  • The present study suggests that BT/A is safe and effective in improving the motor functional disability which is often associated with severe localized muscle spasticity.[ncbi.nlm.nih.gov]
  • However, at present the dose of BTX-A for a given patient is selected empirically. The aim of this study is to provide dosage guidelines that are based on risk/benefit assessment.[ncbi.nlm.nih.gov]
Weight Gain
  • The most common nutritional problems include: Difficulty chewing or swallowing foods, which may result in inadequate nutritional intake Poor weight gain and poor growth (in children) or difficulty managing weight Excessive weight gain Constipation Increased[uclaccp.org]
  • gain secondary to high caloric expenditure Sleep disturbance Depression secondary to lack of functional independence Advantages of spasticity Spasticity can confer certain benefits to the patient, including the following: Substitutes for strength, allowing[emedicine.com]
Bladder Distention
  • These include: Bladder distention Bowel impaction Deep venous thrombosis Extreme temperatures Fatigue Infection Noxious stimuli Poor posture Pressure sore Stress These factors are believed to cause a temporary worsening of the condition and further increase[news-medical.net]
  • distention Bowel impaction Cold weather Fatigue Seizure activity Stress Malpositioning Prognosis Spasticity can have a devastating effect on function, comfort, and care delivery, and it also may lead to musculoskeletal complications.[emedicine.com]
Hyperreflexia
  • Spasticity is usually accompanied by HYPERREFLEXIA and variable degrees of MUSCLE WEAKNESS.[profiles.umassmed.edu]
  • Positive components include muscle overactivity, flexor and extensor spasm, hyperreflexia, athetosis, spastic dystonia, clonus, and an extensor plantar response.[bjmp.org]
  • This ultimately leads to hyperreflexia, an exaggerated deep tendon reflex. Spasticity is often treated with the drug baclofen, which acts as an agonist at GABA receptors, which are inhibitory.[en.wikipedia.org]
  • In addition to weakness and increased muscle tone, the signs in spasticity include the following (see Clinical Presentation): Clonus Clasp-knife phenomenon Hyperreflexia Babinski sign Flexor reflexes Flexor spasms Spasticity can be severely debilitating[emedicine.com]
Trigeminal Neuralgia
  • It has also been shown to be clinically effective in the management of pain syndromes, such as: myofascial pain, lower back pain and trigeminal neuralgia. This review summarizes the recent findings on the clinical application of tizanidine.[ncbi.nlm.nih.gov]
Unable to Walk
  • When I get stressed however, I immediately feel my legs start to tighten up and cramp causing me to feel like if I don't start stretching and massaging them right away that they might (but probably not) lock up rendering me unable to walk.[mattsms.com]

Workup

  • […] to quantify, [3] but clinically useful scales include the following: Ashworth Scale/Modified Ashworth: From 0-4 (normal to rigid tone) Physician's Rating Scale: Gait pattern and range of motion assessed Spasm Scale: From 0-4 (no spasms to 10/h) See Workup[emedicine.com]

Treatment

  • No treatment-emergent adverse events were reported during treatments and follow-up visits.[ncbi.nlm.nih.gov]
  • There was a general agreement on the indications for treatment but the average dose of BtxA used varied between centres. One treatment centre used general anaesthesia (GA) prior to injections in most patients.[ncbi.nlm.nih.gov]
  • The best treatment outcomes are usually achieved when pharmacological and non-pharmacological treatment modalities are used in tandem.[ncbi.nlm.nih.gov]
  • Before treatment, the HmaxlMmax ratio was significantly higher in the affected side than in the unaffected side. However, it was similar at both sides after treatment.[ncbi.nlm.nih.gov]
  • INTERVENTIONS: The control group received conventional therapy, and the treatment group received hippotherapy in addition to their conventional treatment. The intervention consisted of a 12-weeks hippotherapy program (1 time/week, 45 min).[ncbi.nlm.nih.gov]

Prognosis

  • Physical therapy also plays a key role in the fight against spasticity and the prognosis of spinal cord injuries in general. By helping you control your muscles, physical therapy can steadily reduce the effects.[spinalcord.com]
  • This surveillance is an important part of treatment, because continued monitoring lets doctors recommend intervention when it best helps a child’s long-term prognosis.[nyulangone.org]
  • (See Prognosis, Treatment, and Medication.) While the incidence of spasticity is not known with certainty, the condition likely affects over half a million people in the United States and over 12 million people worldwide.[emedicine.com]

Etiology

  • Although the exact etiology is unknown, it is believed that the CNS damage increases the excitability of the stretch reflex receptors in the muscles, causing the muscles to contract in response.[news-medical.net]
  • (See Pathophysiology and Etiology.) Spasticity usually is accompanied by paresis and other signs, such as increased stretch reflexes, which collectively are called upper motor neuron syndrome.[emedicine.com]

Epidemiology

  • Authors’ Affiliations (1) Epidemiology & Database Analytics, United BioSource Corporation, Lexington, MA, USA (2) Neurosciences, Medical Affairs, Allergan, Inc, Irvine, CA, USA (3) Health Economics and Epidemiology, Evidera, Lexington, MA, USA (4) Rehabilitation[bmcneurol.biomedcentral.com]
  • Cerebral palsy epidemiology: Where are We Now and where are We going? Dev Med Child Neurol. 1992;34:547–51. View Article PubMed Google Scholar Dunne JW, Heye N, Dunne SL. Treatment of chronic limb spasticity with botulinum toxin A.[jneuroengrehab.biomedcentral.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology The specific pathophysiology of spasticity is not clear but several theories have been suggested to explain the cause of the condition.[news-medical.net]
  • Spasticity Management Determining the impact of spasticity and need for treatment Spasticity in SCI varies with location and degree depending on the injury pathophysiology.[rnoh.nhs.uk]
  • Pathophysiology The pathophysiologic basis of spasticity is incompletely understood.[emedicine.com]

Prevention

  • It allows passive limb mobilization in a comprehensive rehabilitation program that attempts to prevent fixed soft tissue contractures.[ncbi.nlm.nih.gov]
  • Simple coordination and stability exercises can help prevent falls among older adults.[livestrong.com]
  • Our neuromuscular experts work together to provide children who have cerebral palsy with the care they need to relieve spasticity and prevent progressive damage to muscles and joints.[nyulangone.org]
  • Physical therapists can do periodic assessment to try to prevent long term problems, such as excessive wear and tear on shoulders from wheeling.[archive.myelitis.org]
  • Treatment of spasticity and muscle tightness by medication and physical and occupational therapy is needed to prevent painful and disabling contractures in the hips, knees, ankles, shoulders, and elbows.[ms.pitt.edu]

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