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Spasms and Spasticity 

What are Spasms?


What is a reflex?


Why do they happen?

  • Reflexes are activated
  • Brain control is lost
  • Uncontrolled reflexes

Who gets them?

  • People who have a spinal cord injury with damage to the nerves that control reflexes

Example of a spasm:

  • Bed sheet moved across skin
  • Sensors send message of touch from skin to spinal cord
  • Message continues to nerve which leads to a muscle
  • Message is not controlled by the brain to stop unnecessary movement
  • Movement (spasm) occurs

What is Spasticity?

  • Increased stiffness of muscles
  • It could make movements difficult e.g. when carers move legs to turn you
  • As movements become difficult this could cause loss of range of movement in joints

Why does it happen?

  • Messages from the brain tells muscles to contract and relax
  • There is an imbalance of messages to contract and relax following spinal cord damage
  • Loss of range of movement with prolonged periods in shortened positions
  • Muscle tissue changes

Example of Spasticity:

  • Lying in bed, calf muscle contracts causing toes to point
  • If not corrected with foot splint or pillows then the muscle will start to shorten
  • Shortened muscle becomes more stiff and difficult to correct its position
  • Shortening leads to problems for people positioning on foot plates, and standing

What can affect Spasms/Spasticity?

  • Pain - External/ Internal
  • Temperature - environment or illness
  • Skin condition
  • Pressure
  • Tight muscles and stiff joints
  • Fractures
  • Poor positioning or handling
  • Stress and emotions
  • Effort /fatigue
  • Environment
  • Alcohol Withdrawal

What can help?

  • Positioning
  • Passive movements/normal movement patterns
  • Facilitating normal movement
  • Positioning in wheelchair
  • Stretching (joints&muscles)
  • Standing / weight bearing
  • Care of bladder and bowel
  • Care of foot and nail
  • Warmth
  • Drugs / Surgery
  • Relaxation
  • FES
  • Orthotics / splinting

Advantages of Spasms/Spasticity

  • Help maintain muscle bulk & protect bony prominences
  • Improve circulation
  • Warning system
  • Can help with functional activities

Disadvantages of Spasms/ Spasticity

  • Effect on balance
  • Effect on transfers
  • Effect on daily activities
  • Contractures
  • Pain
  • Feelings of tightness
  • Difficulty breathing (abdominal)
  • Pressure sores

Medical Management

Drugs

Baclofen

  • Most widely used oral medication
  • Inhibits nerve messages
  • Acts on nervous system includingspinal cord
  • Side effects: dizziness, drowsiness, nausea
  • Dose: max 100-120mg daily
  • Problems with sudden withdrawal

Diazepam

  • Stops nerve messages in nervous system
  • Side effects: dizziness, drowsiness
  • Dose: max 60mg daily

Dantrolene

  • Acts directly on muscle
  • Interferes with chemicals needed for muscle contraction
  • Side effects: dizziness, nausea
  • Dose: max 100mg 4 x daily

Tizanidine (Zanaflex)

  • Acts on nervous system, blocking nerve messges
  • Side effects: dizziness, drowsiness, fatigue
  • Dose: max 36mg daily

Injections

Botulinum Toxin

  • Only works on targetted muscles
  • Stops nerve messages getting to specific muscles, for short period of time
  • Not suitable for use in multiple muscles as problems with high doses
  • Used in conjunction with other therapies
  • - Alcohol / Phenol

Surgical Interventions

  • Intrathecal Baclofen Pump
  • Tendon releases
  • Cutting nerves

In Summary

Effective management of spasticity requires the whole rehabilitation team to work together in planning and implementing treatment with the patient.

If you are having problems with spasm please contact either your G.P or the Spinal Centre for advice.

Page Last Updated: 1/30/2016 3:26 PM 
Printed from Salisbury NHS Foundation Website http://www.salisbury.nhs.uk