Spasticity is a symptom of neurological conditions like brain injury, spinal cord injury or stroke. The condition is marked by stiff, rigid muscles that impede natural movement. While patients with spasticity often struggle to walk, move and speak, therapy can help regain range of motion and prevent further complications.
Spasticity causes muscles in an area of the body to contract at all once. That’s because neurological conditions damage the nerves of our central nervous system, disrupting typical movement patterns. “There’s damage to the brain or spinal cord that causes the initial injury. And then some of the nerve pathways — those descending pathways that go from the brain to the muscles — become overexcited,” explained Kristin Morrison, physical therapy team leader at Encompass Health Rehabilitation Hospital of Chattanooga. The contracted muscles are difficult to stretch, limiting the range of motion. “If a patient can’t move well, they can’t do functional activities. For example, if the shoulder joint becomes immovable, it’s really hard to dress and maintain hygiene.”
Spasticity can affect the joints in both upper and lower extremities including ankles, knees, hips, elbows, shoulders and wrists.
Symptoms and Severity Varies
Spasticity affects each patient differently. Common symptoms include:
- Muscle tightness
- Joint stiffness
- Involuntary jerky movements
- Unusual posture
- Abnormal positioning of fingers, wrists, arms or shoulders
- Muscle spasms
- Muscle fatigue
- Involuntary crossing of the legs, also called “scissoring”
In more severe cases, spasticity can lead to contractures — permanent tightening of the muscles, tendons, skin and surrounding tissues that causes the joints to shorten and stiffen. “If patients have very rigid muscles and joints and little available range for movement they can develop contractures at the joint making it basically immovable. Eventually you end up with joint, muscle and tendon changes that make it even more difficult to move and more of a permanent situation,” Morrison said.
Treating Spasticity in Therapy
A combination of physical, occupational and speech therapy can benefit patients with spasticity to help them ease symptoms, maintain range of motion and improve function. If you require therapy, your doctor might recommend inpatient rehabilitation, a hospital setting of care where you’ll receive three hours of therapy five days per week under the guidance of a rehabilitation physician.
Evaluating Spasticity in Inpatient Rehabilitation
In an inpatient rehabilitation setting, therapists assess patients with spasticity, focusing on their area of expertise. “In physical therapy, we’re concerned with the lower and upper extremities. Occupational therapy usually does more upper extremities and can look into custom hand splints. Speech therapists look at speech, postural muscles and the muscles of the face, mouth and neck for swallowing and speech production,” explained Morrison.
To determine the severity of the spasticity and the best course of treatment, therapists evaluate the patient’s muscle tone — the muscles’ level of resistance to being stretched — and range of motion using an assessment called the Modified Ashford Scale.
The Modified Ashford Scale puts a numeric value to the patient’s muscle tone from zero up to four. “A normal level of muscle tone on the MAS is a zero, and then it goes to a level one, two and all the way up to a level four, which would be that the affected extremities are very rigid and are very difficult to move in either flexion or extension,” Morrison said.
The Importance of Stretching
According to Morrison, stretching is one of the most effective methods in managing spasticity. “I typically get patients on a stretching program immediately where I’m manually stretching them during sessions,” she said. “I also have them do self stretches to maintain or gain range of motion so we don’t end up losing any of that.” Stretching sessions might also include relaxation techniques to ensure patients can get the most out of their therapy sessions.
Morrison stressed the importance of consulting with the patient’s family about their stretching program. “I get the family involved as soon as possible during a patient’s stay because a lot of times patients need help from a caregiver to do some of their stretches when they return home.” Depending on the patient’s individualized care plan, therapists’ consultations with families might include a review of their stretching program and how to assist them in the routine, tips to help their loved one with daily tasks and information about other techniques to help manage spasticity. Therapists will also provide take-home resources such as printouts of recommended exercises and stretches with photos for easy reference.
Other Techniques Used in Therapy
Each care plan is developed to address the patient’s needs. In addition to stretching, your therapy might also include:
- Practicing daily tasks: If patients are struggling to perform everyday activities like standing up and getting dressed, therapists can assist patients by breaking down the tasks into easier steps. For example, Morrison said, “I might break it down. Instead of a full stand, we start with a quarter stand, and we work our way toward a full stand as they get more neurological recovery.”
- Addressing movement patterns: Because high effort can worsen spasticity, therapists help patients learn to be more selective in how they move so they aren’t using too much effort. “We help them use the appropriate movement patterns and the appropriate muscle groups and getting the timing so that they can be successful.” Ultimately, that develops new neurological patterns to build up strength and function.
- Technology and assisted movement: Inpatient rehabilitation hospitals offer therapy gyms with equipment such as body weight supporting treadmills that allow patients to walk with support of their upper body. Patients in therapy might also use walkers and wheelchairs as they work up to walking with limited assistance or no assistance at all.
- Casting or bracing: In some cases, patients are given casts or braces for the affected areas of the body to help stretch and support spastic muscles.
In addition to therapy, your treatment might also include:
- Medication: Common prescriptions for spasticity are muscle relaxants, sedatives and nerve blockers.
- Injections: Botulinum toxin, more commonly known as Botox, injected into spastic muscles can help tight muscles relax, relieving symptoms.