Ability Forum

[Kr_iyer]

Spasticity
Spasticity is uncontrollable muscle tightness in an arm or leg that can cause painand affects movement. This involuntary muscle contraction is a common physical response after strokes and other brain injuries. Spastic muscles are stiffor tight and may interfere with gait, movement, and speech. Spasticity is usually caused by damage to the portion of the brain or spinal cord that controls voluntary movement. Spasticity can be limited to just an arm or a leg or it can involve a whole side of the body. Spasticity usually co-exists with weakness. As the brain injury begins to heal and voluntary movements return to the arms and legs spasticity may decrease, restoring the usefulness of the limb. A healthy brain tells muscles when to contract and when to relax. In a stroke survivor with spasticity, muscle may be active even when the brain’s order is to relax.Instead of muscles waiting to be told to contract, they are constantly turned “on” making voluntary movementshard to control by the nervous system. Following stroke, spasticity can occur in any group of muscles, but is most common in the arm. A spastic arm has a characteristic posture of a tight fist, bent elbow and arm held against the chest. This posture can seriously interfere with a stroke survivor’s ability to perform daily activities such as dressing and eating. Spasticity in the leg usually causes a stiff knee and a pointed foot that can make walking difficult because it is difficult to move the foot forward without hitting the ground. In the past therapists believed that spasticity had to be decreased before muscle control improved. They also believed that strengthening spastic muscles should be avoided because it would just increase the spasticity. Current research shows that gaining muscle control may reduce spasticity and that strengthening spastic muscles actually can improve the control a person has over those muscles. What are the Symptoms or Effects? Stiffness in the arms, fingers or legs Painful muscle spasmsA series of involuntary rhythmic contractions and relaxations in a muscle or group of muscles that lead to uncontrollable movement or jerking Increased muscle “tone” Abnormal posture Hyperactive reflexes -
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Page 2
What treatments are available?
Treatments for spasticity usually start from the lowest level of risk or side effects, and only move on to otheroptions if treatment is ineffective and quality of life is significantly decreased. It’s important for patients to discuss appropriate treatments for their individual cases with their physicians. It is also important for patients to allow time for healing after stroke. The body may repair damage in the nervous system, including the brain, in time. Not all damage may be repaired and not all repairs happen within days of the injury. Some repair can take place up to a year after a stroke. Keep in mind that some of these treatments for spasticity take months tocomplete. Even when spasticity is reduced, therapy may be necessary to maintain the range of motion, increase strength, and restore function. STRETCHING AND BASIC CARE A muscle-stretching program performed at least one or two times daily is considered a key management technique for spasticity. This is especially important early after the stroke. The spastic limb should be moved through a full range of motion. A recent study in Physical Therapy suggests that for people 65 years and older, stretches should be performed at a low intensity and held for at least 60 seconds to achieve the best potential physiological changes in the muscle1. This means that at the point where a person starts to feel some discomfort,they should hold the stretch there for 60 seconds. A stretching program for an arm should include stretches for the shoulder, elbow, wrist and hand. Remember to move through as much range as possible to avoid stiffening of the joint and its surrounding tissues. The shoulder is particularly susceptible to injury when stretched improperly.Your therapist should instruct you in the correct stretching techniques. For the hand and wrist, one can usually use their other hand to stretch out the joints. Keep in mind that each finger needs attention! Including the thumb! Loose ankles and toes are important because good motion is necessary for proper walking! Pumping your ankle up and down is one of the easiest and most important exercises you can do with your leg. And as with all treatment, please be sure to check with your doctor, physical therapist or occupational therapist on whatstretching program is right for you. ELECTRICAL STIMULATIONElectrical stimulation may be used to help strengthen weak or spastic muscles. It may also reduce spasticity for short periods of time. Electrical stimulation is most often used to help flex the ankle for walking, and to help extend spastic fingers. BIOFEEDBACKBiofeedback is the use of an electrical monitor that uses a signal—usually a sound or light—to indicate the activity in muscles. In this way, the person with spasticity may be able to train himself to control the level of muscle activity consciously. There has been little research testing the effectiveness of biofeedback for reducing spasticity. TEMPORARY STRATEGIES If stretching also is not sufficient, casts and splints may be helpful to improve range of motion in spastic limbs. There are many types of splints and casts that are available. Some are pre-fabricated and can fit most needs. Some people may need custom made casts and splints, these can be made by your occupational or physical therapist. Other short-term techniques include applying cold to reduce spastic tone. Believe it or not, an ice pack can help alleviate some of the symptoms associated with spastic muscles.
--------------------------------------------------------------------------------
Page 3
What medical treatments are available?
ORAL MEDICATION Because of the wide range of problems caused by spasticity, it’s doubtful that any one medication will help manage all the effects of spasticity. In addition, all drugs used in treatment of spasticity may have side effects, which should be weighed against their benefit. Baclofen (Lioresal) decreases muscle spasticity by reducing muscle spasms, and increasing range of motion. It may also improve bladder control in selected patients. Side effects may include hallucinations, confusion, sedation, loss of muscle tone, poor muscular coordination and weakness in non-affected muscles. Dantrolene sodium (Dantrium) weakens spastic muscles and has little effect on normal muscles. Dantrolene may cause drowsiness, depression, nausea, vomiting, dizziness, diarrhea and liver malfunctioning. Tizanidine hydrochloride (Zanaflex) is a recently approved treatment for spasticity. Clinical trials have shown it to be equal to baclofen in reducing spasticity, but bettertolerated. In addition, studies have demonstrated that Zanaflex, unlike all other oral spasticity medications, does not cause muscle weakness. Side effects include low blood pressure, sleepiness and dry mouth. Nerve Block Injections Botulinum toxin (Botox) is injected into muscles to relax their spasticity by blocking nerve impulses that cause muscles to contract. While oral medications affect multiple muscles in the body, Botox injections target only the specific musclesthat are injected. A single injection can relax affected muscles for three to six months before the effects wear off. Side effects include soreness and swelling at the injection site, fatigue, excess muscle weakness and possible antibody formation. Botulinum toxin is most effective for managing spasticity in localized areas such asa specific limb or muscle group. Clinical studies have shown Botox to be effective in patients with spasticity, however the Food and Drug Administration have not yet approved it for treating spasticity. There are several research studies on going. Phenol is a type of alcohol injection that blocks nerves in spastic muscles to reduce the spasticity. It is similarto Botulinum toxin in the length of effectiveness and patient selection. Neither block is suitable for patients with full-body spasticity because the treatment is technologically difficult. Phenol injections may cause pain. Spinal MedicationIntrathecal Baclofen (ITB) Therapy delivers a liquid form of baclofen directly to the spinal fluid via a small pump that is surgically placed under the skin. Since the medication does not circulate throughout the body, only small doses are required to be effective, reducing the side effects common with oral baclofen. ITB Therapy has been shown to be effective in people with severe spasticity, including some who have not had good results with oral medications. The most common device-related complications are kinks, dislodgments, or breaks in the catheter that delivers the drug from the device into the spinal fluid. The most common ITB Therapy drug side effects include loose muscles, drowsiness, nausea/vomiting, headache and dizziness.
--------------------------------------------------------------------------------
Page 4
What other treatments are available?
Orthopedic SurgerySurgery on specific muscles can improve movement in patients with severe spasticity. One of the most common surgical procedures to improve the ability to walk is thesplit anterior tibial transfer (SPLATT). In a SPLATT operation, the surgeon splits a tendon that makes the footturn inward and moves half of the tendon to the outside of the foot where it can help straighten and balance the foot as a walking surface. Surgery to cut and transfer tendons is also performed on other problematic muscles. NeurosurgeryNeurosurgery is reserved as a last resort when other methods fail. Nerves can be surgically cut to create a more permanent disruption of nerve function than a local chemical block. In a surgery called dorsal rhizotomy, used more frequently in children with spasticity, sensory nerves are severed as they enter the spinal cord, interrupting the spinal reflex arc and reducing spasticity permanently. So Remember… You CAN do something about your spasticity. STRENGTHENING EXERCISES for spastic muscle can help you to gain control of affected muscles. STRETCHING is a good first step in controlling spasticity.There are SEVERAL medications that can reduce spasticity, with new ones under development. Surgery may be an option for some patients with severe spasticity

_________________
If they answer not to thy call walk alone,
If they are afraid and cower mutely facing the wall,
O thou unlucky one,
open thy mind and speak out alone.
RABINDRANATH TAGORE

Spasticity
Spasticity is uncontrollable muscle tightness in an arm or leg that can cause painand affects movement. This involuntary muscle contraction is a common physical response after strokes and other brain injuries. Spastic muscles are stiffor tight and may interfere with gait, movement, and speech. Spasticity is usually caused by damage to the portion of the brain or spinal cord that controls voluntary movement. Spasticity can be limited to just an arm or a leg or it can involve a whole side of the body. Spasticity usually co-exists with weakness. As the brain injury begins to heal and voluntary movements return to the arms and legs spasticity may decrease, restoring the usefulness of the limb. A healthy brain tells muscles when to contract and when to relax. In a stroke survivor with spasticity, muscle may be active even when the brain’s order is to relax.Instead of muscles waiting to be told to contract, they are constantly turned “on” making voluntary movementshard to control by the nervous system. Following stroke, spasticity can occur in any group of muscles, but is most common in the arm. A spastic arm has a characteristic posture of a tight fist, bent elbow and arm held against the chest. This posture can seriously interfere with a stroke survivor’s ability to perform daily activities such as dressing and eating. Spasticity in the leg usually causes a stiff knee and a pointed foot that can make walking difficult because it is difficult to move the foot forward without hitting the ground. In the past therapists believed that spasticity had to be decreased before muscle control improved. They also believed that strengthening spastic muscles should be avoided because it would just increase the spasticity. Current research shows that gaining muscle control may reduce spasticity and that strengthening spastic muscles actually can improve the control a person has over those muscles. What are the Symptoms or Effects? Stiffness in the arms, fingers or legs Painful muscle spasmsA series of involuntary rhythmic contractions and relaxations in a muscle or group of muscles that lead to uncontrollable movement or jerking Increased muscle “tone” Abnormal posture Hyperactive reflexes -
-------------------------------------------------------------------------------
Page 2
What treatments are available?
Treatments for spasticity usually start from the lowest level of risk or side effects, and only move on to otheroptions if treatment is ineffective and quality of life is significantly decreased. It’s important for patients to discuss appropriate treatments for their individual cases with their physicians. It is also important for patients to allow time for healing after stroke. The body may repair damage in the nervous system, including the brain, in time. Not all damage may be repaired and not all repairs happen within days of the injury. Some repair can take place up to a year after a stroke. Keep in mind that some of these treatments for spasticity take months tocomplete. Even when spasticity is reduced, therapy may be necessary to maintain the range of motion, increase strength, and restore function. STRETCHING AND BASIC CARE A muscle-stretching program performed at least one or two times daily is considered a key management technique for spasticity. This is especially important early after the stroke. The spastic limb should be moved through a full range of motion. A recent study in Physical Therapy suggests that for people 65 years and older, stretches should be performed at a low intensity and held for at least 60 seconds to achieve the best potential physiological changes in the muscle1. This means that at the point where a person starts to feel some discomfort,they should hold the stretch there for 60 seconds. A stretching program for an arm should include stretches for the shoulder, elbow, wrist and hand. Remember to move through as much range as possible to avoid stiffening of the joint and its surrounding tissues. The shoulder is particularly susceptible to injury when stretched improperly.Your therapist should instruct you in the correct stretching techniques. For the hand and wrist, one can usually use their other hand to stretch out the joints. Keep in mind that each finger needs attention! Including the thumb! Loose ankles and toes are important because good motion is necessary for proper walking! Pumping your ankle up and down is one of the easiest and most important exercises you can do with your leg. And as with all treatment, please be sure to check with your doctor, physical therapist or occupational therapist on whatstretching program is right for you. ELECTRICAL STIMULATIONElectrical stimulation may be used to help strengthen weak or spastic muscles. It may also reduce spasticity for short periods of time. Electrical stimulation is most often used to help flex the ankle for walking, and to help extend spastic fingers. BIOFEEDBACKBiofeedback is the use of an electrical monitor that uses a signal—usually a sound or light—to indicate the activity in muscles. In this way, the person with spasticity may be able to train himself to control the level of muscle activity consciously. There has been little research testing the effectiveness of biofeedback for reducing spasticity. TEMPORARY STRATEGIES If stretching also is not sufficient, casts and splints may be helpful to improve range of motion in spastic limbs. There are many types of splints and casts that are available. Some are pre-fabricated and can fit most needs. Some people may need custom made casts and splints, these can be made by your occupational or physical therapist. Other short-term techniques include applying cold to reduce spastic tone. Believe it or not, an ice pack can help alleviate some of the symptoms associated with spastic muscles.
--------------------------------------------------------------------------------
Page 3
What medical treatments are available?
ORAL MEDICATION Because of the wide range of problems caused by spasticity, it’s doubtful that any one medication will help manage all the effects of spasticity. In addition, all drugs used in treatment of spasticity may have side effects, which should be weighed against their benefit. Baclofen (Lioresal) decreases muscle spasticity by reducing muscle spasms, and increasing range of motion. It may also improve bladder control in selected patients. Side effects may include hallucinations, confusion, sedation, loss of muscle tone, poor muscular coordination and weakness in non-affected muscles. Dantrolene sodium (Dantrium) weakens spastic muscles and has little effect on normal muscles. Dantrolene may cause drowsiness, depression, nausea, vomiting, dizziness, diarrhea and liver malfunctioning. Tizanidine hydrochloride (Zanaflex) is a recently approved treatment for spasticity. Clinical trials have shown it to be equal to baclofen in reducing spasticity, but bettertolerated. In addition, studies have demonstrated that Zanaflex, unlike all other oral spasticity medications, does not cause muscle weakness. Side effects include low blood pressure, sleepiness and dry mouth. Nerve Block Injections Botulinum toxin (Botox) is injected into muscles to relax their spasticity by blocking nerve impulses that cause muscles to contract. While oral medications affect multiple muscles in the body, Botox injections target only the specific musclesthat are injected. A single injection can relax affected muscles for three to six months before the effects wear off. Side effects include soreness and swelling at the injection site, fatigue, excess muscle weakness and possible antibody formation. Botulinum toxin is most effective for managing spasticity in localized areas such asa specific limb or muscle group. Clinical studies have shown Botox to be effective in patients with spasticity, however the Food and Drug Administration have not yet approved it for treating spasticity. There are several research studies on going. Phenol is a type of alcohol injection that blocks nerves in spastic muscles to reduce the spasticity. It is similarto Botulinum toxin in the length of effectiveness and patient selection. Neither block is suitable for patients with full-body spasticity because the treatment is technologically difficult. Phenol injections may cause pain. Spinal MedicationIntrathecal Baclofen (ITB) Therapy delivers a liquid form of baclofen directly to the spinal fluid via a small pump that is surgically placed under the skin. Since the medication does not circulate throughout the body, only small doses are required to be effective, reducing the side effects common with oral baclofen. ITB Therapy has been shown to be effective in people with severe spasticity, including some who have not had good results with oral medications. The most common device-related complications are kinks, dislodgments, or breaks in the catheter that delivers the drug from the device into the spinal fluid. The most common ITB Therapy drug side effects include loose muscles, drowsiness, nausea/vomiting, headache and dizziness.
--------------------------------------------------------------------------------
Page 4
What other treatments are available?
Orthopedic SurgerySurgery on specific muscles can improve movement in patients with severe spasticity. One of the most common surgical procedures to improve the ability to walk is thesplit anterior tibial transfer (SPLATT). In a SPLATT operation, the surgeon splits a tendon that makes the footturn inward and moves half of the tendon to the outside of the foot where it can help straighten and balance the foot as a walking surface. Surgery to cut and transfer tendons is also performed on other problematic muscles. NeurosurgeryNeurosurgery is reserved as a last resort when other methods fail. Nerves can be surgically cut to create a more permanent disruption of nerve function than a local chemical block. In a surgery called dorsal rhizotomy, used more frequently in children with spasticity, sensory nerves are severed as they enter the spinal cord, interrupting the spinal reflex arc and reducing spasticity permanently. So Remember… You CAN do something about your spasticity. STRENGTHENING EXERCISES for spastic muscle can help you to gain control of affected muscles. STRETCHING is a good first step in controlling spasticity.There are SEVERAL medications that can reduce spasticity, with new ones under development. Surgery may be an option for some patients with severe spasticity

_________________
If they answer not to thy call walk alone,
If they are afraid and cower mutely facing the wall,
O thou unlucky one,
open thy mind and speak out alone.
RABINDRANATH TAGORE

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[Kr_iyer]

Hi All,

I read this article sometime back, and after consulting Physiotherapist, I decided to shape up my muscles and try to reduce my spasticity. Previous to my stroke , I used to pedal exercise cycle. I choose the cycle with

1. Pedal Straps to hold my legs
2. To have diffferent tightening of wheels
3. To have afjustable seat heights
4. Movement seperate for Row type of Handle bar

I started  with seat height at the lowest and leaving right hand started pedaling and swinging . To continuosly driving 20 Mins I could not concentrate. then I selected Sloka for 20 mins on my mobile and dpractisd till it ends. As we know any aerobic is pulse rate/ breathing changing., but check your heart before you start. Then I tried my right hand to hold the bar and failed. Then My dad suggested to tie a cloth and hold it . My fingers can bend inwards not out wards.  Yeah it worked Now I Do twice a day morn and eve. Te result is my pants havebecame loose and left hand biceps showing and my right hand bit relaxed. the biggest thing is the legs, I can walk comfortably without dragging it. I can lift it. Still it is a far away distance.

Well you can see the pics of cycle and me practisig

1. http://www.flickr.com/photos/kr_iyer/3352642771/
2. http://www.flickr.com/photos/kr_iyer/3353467310/
3. http://www.flickr.com/photos/kr_iyer/3353467112/
4. http://www.flickr.com/photos/kr_iyer/3353466058/


Well bye

_________________
If they answer not to thy call walk alone,
If they are afraid and cower mutely facing the wall,
O thou unlucky one,
open thy mind and speak out alone.
RABINDRANATH TAGORE

Hi All,

I read this article sometime back, and after consulting Physiotherapist, I decided to shape up my muscles and try to reduce my spasticity. Previous to my stroke , I used to pedal exercise cycle. I choose the cycle with

1. Pedal Straps to hold my legs
2. To have diffferent tightening of wheels
3. To have afjustable seat heights
4. Movement seperate for Row type of Handle bar

I started  with seat height at the lowest and leaving right hand started pedaling and swinging . To continuosly driving 20 Mins I could not concentrate. then I selected Sloka for 20 mins on my mobile and dpractisd till it ends. As we know any aerobic is pulse rate/ breathing changing., but check your heart before you start. Then I tried my right hand to hold the bar and failed. Then My dad suggested to tie a cloth and hold it . My fingers can bend inwards not out wards.  Yeah it worked Now I Do twice a day morn and eve. Te result is my pants havebecame loose and left hand biceps showing and my right hand bit relaxed. the biggest thing is the legs, I can walk comfortably without dragging it. I can lift it. Still it is a far away distance.

Well you can see the pics of cycle and me practisig

1. http://www.flickr.com/photos/kr_iyer/3352642771/
2. http://www.flickr.com/photos/kr_iyer/3353467310/
3. http://www.flickr.com/photos/kr_iyer/3353467112/
4. http://www.flickr.com/photos/kr_iyer/3353466058/


Well bye

_________________
If they answer not to thy call walk alone,
If they are afraid and cower mutely facing the wall,
O thou unlucky one,
open thy mind and speak out alone.
RABINDRANATH TAGORE