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Simon Fishman, MD
Tackling Spasticity From Infantile Cerebral Palsy To Fisted Hand After Stroke
Integrated Neurology Services

Tackling Spasticity From Infantile Cerebral Palsy To Fisted Hand After Stroke

What is spasticity? It is a group of conditions that affects many neurologic patients when the brain or spinal cord fails to mature correctly or is injured by trauma, inflammation or stroke.

Spasticity is defined as an involuntary, velocity dependent, increased resistance to passive manipulation. Otherwise stated, the muscles can't relax from a fixed position.

Spasticity is characterized by muscle stiffness and a wide range of involuntary muscle spasms that can interfere with walking, movement, or speech.

If only one side of the brain is affected, as in a stroke, a patient may present with tightness described as spastic hemiparesis.

These patients often will have contractures (“decreased range of motion”) of the hand, wrist or elbow. When they walk they hold the arm in a flexed position against their body and might hike up their hip on the affected side so that their extended leg and foot can “swing” around to take a step.

Those with injury to the spinal cord will walk with their knees locked together in a scissoring manner, similarly to those who had brain injury prior to birth (spastic diplegia, Cerebral Palsy).

One of the most common causes of spasticity in young adults is Multiple Sclerosis, affecting as many as one in three patients with the disease.

Spasticity can be immediate or delayed in onset from the time of injury. Spasticity may not be present all the time-it may be related to a trigger such as pain, pressure sores, a urinary tract infection, stress, ingrown toenails, tight clothing, or constipation.

Because spastisity makes personal hygiene more difficult, patients are at a higher likelihood to develop skin, lung, and urinary tract infections. Spasticity is a major contributor to gait instability and falls.

The initial assessment and treatment is dependent on many factors including the severity of the spasticity. Therapies include oral medications, injections of botulitim toxin, or implantable devices that deliver medicine directly into the spinal canal.

There is no single treatment that “cures” spasticity but the combination of therapy can help substantially.

Occasionally, patients with severe spasticity or contractures will have difficulty making further progress without operative treatments. For a small fraction of patients, tendon or spinal cord surgery can be very helpful.

An effective spasticity program requires a team approach to treatment. The key is having an experienced neurologist help guide you in your treatment decisions and connect you with proper physical and occupational therapists, orthopedic and neurological surgeons, and orthotic specialists.

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