Sci_spasticity.indd

What is spasticity?Spasticity is the uncontrolled tightening or contracting of the muscles that is common in individuals with spinal cord injuries. About 65%–78% of the SCI population have some amount of spasticity, and it is more common in cervical (neck) than thoracic (chest) and lumbar (lower back) injuries . Symptoms and severity of spasticity vary from person to person and can include:  Sudden, involuntary fl exing (bending) or extending (straightening) of a limb, or jerking of muscle groups such as in the trunk (chest, back, and abdomen),  Hyperactive (overactive) refl exes, such as a muscle spasm when you are  Stiff or tight muscles at rest, so that it is diffi cult to relax or stretch your  Muscle tightness during activity, making it diffi cult for you to control your What causes spasticity?The nerves of the spinal cord and brain form a complex communication circuit that controls our body movements. Information on sensations or processes such as touch, movement or muscle stretch is sent up the spinal cord to the brain. In response, the brain interprets the signal and sends the necessary commands back down the spinal cord to tell your body how to react. The reaction of the body, such as jerking away from a hot object, is a refl ex and After a spinal cord injury, the normal fl ow of signals is disrupted, and the mes- sage does not reach the brain. Instead, the signals are sent back to the motor cells in the spinal cord and cause a refl ex muscle spasm. This can result in a twitch, jerk or stiffening of the muscle. Just about any touch, movement or irritation can trigger and sustain spasms. Common triggers are:
 Any irritation to the skin, such as rubbing, chafi ng, a rash, in-grown toenails, or anything that would normally be very hot or cold or cause pain.  A urinary tract infection or full bladder. Spinal Cord Injury Model Systems Consumer Information
Copyright 2011 Model Systems Knowledge Translation Center (MSKTC).
 Constipation or large hemorrhoids.
 Fracture or other injury to the muscles, tendons The following treatments will help to maintain fl ex- or bone below the level of spinal cord injury. ibility and therefore reduce spasticity and the risk Spasticity can be irritating, inconvenient or even  Regular stretching (range-of-motion) exercises limit your ability to go through your day. twice daily will help maintain fl exibility and tem-porarily reduce muscle tightness.
 Weight-bearing or standing with support, such as using a standing frame or other supportive Spasticity is not always harmful or bothersome and does not always need to be treated. Sometimes  Splints, braces, or progressive casting into the spasticity can help with functional activities such as desired position provides continuous muscle standing or transferring. Spasticity that causes your stretching that helps to maintain fl exibility and a fi ngers to bend can help you grip objects. Spastic- position that does not trigger a spasm.
ity can also be a signal that you have a medical problem that you might not know about other-  Careful use of hot or cold packs. When used in wise, such as a urinary tract infection, fracture, or body areas that have partial sensation, check skin tolerance frequently as it may result in a burn if too hot and frostbite if too cold. Avoid the use of hot When physical measures are not enough to control  Spasticity can result in loss of range of motion in  Oral medications
 Severe spasms can make it diffi cult for you If spasticity involves large areas of your body, your to drive or transfer safely, or to stay properly doctor may prescribe one or more of the following  Spasticity in your chest muscles may make it dif- • Benzodiazepines (muscle relaxants) such as  Strong spasms in the trunk or legs can cause you to fall out of your wheelchair when you change position, transfer, or ride over uneven surfaces. The effectiveness of these medications varies with  Repeated muscle spasms at night can cause you each person. Because these medications can have to sleep poorly and be tired during the day. side effects such as fatigue or drowsiness, weakness,  Spasms can cause rubbing that leads to skin nausea, or sometimes low blood pressure, your provider needs to monitor you closely.
 Spasticity can make movement harder to con-  Nerve or motor point blocks
trol, so that activities such as feeding yourself If only part of your body has spasticity, anesthetic medications, alcohol, phenol or neurotoxins (such as strains of botulinum toxin) can be injected into Spinal Cord Injury Model Systems Consumer Information
the muscles that have spasticity. The medications First, practice healthy behaviors and good self-care rarely cause widespread side-effects. The benefi ts of that will help you avoid problems that can increase the injections are only temporary, however, so in- spasticity, such as urinary tract infections and skin jections must be repeated a few times a year. These breakdown. Check to see if any of the common injections can be used alone or in combination with triggers listed above may be causing the problem.  Intrathecal medication therapy (also
Discuss your specifi c needs and treatment options called a “pump” or “baclofen pump”)
with your health care provider or team. You may Intrathecal drug therapy uses a surgically placed, need to try different methods, medications, or battery-powered pump and an attached catheter combinations of treatments before you feel your to deliver medication directly into the spinal canal, spasticity is under control. Consider the following around the spinal cord (called the “intrathecal” questions and discuss them with your provider: space). The most commonly used intrathecal drug  What are your goals for treatment of your for spasticity is baclofen. Intrathecal baclofen can be used in conjunction with the other treatments  How important is it that the treatment can be listed above. This treatment is generally not rec- ommended until other treatments have been tried and failed to provide relief or if oral medications  What are the possible short-term and long-term  Are there other health conditions that would • The drug is delivered directly around the spinal cord, so lower doses of medication are needed.
 If you are considering intrathecal baclofen: Will • Fewer negative side effects because the drug you be able to follow the maintenance require- ments? Do you have a good understanding of • The amount and dosing schedule of drug throughout the day can be precisely set and Whatever treatment you choose, you will need adjusted by the health care provider to meet to work closely with your treatment provider or team to get the best possible outcome.
• The pump can be stopped or removed, if nec- In general, spasticity appears to become less both- • You will need surgery to implant the pump and ersome over time. Possibly this happens because catheter system. Any surgery has risks, such as people learn to avoid things that trigger spasticity. Changes that naturally go on in the body as you • The pump has a limited battery life and will age, such as a slowing down of nerve conduction, need to be replaced about every 5-7 years.
may also decrease spasticity. However, an unex- • You will need to go to your provider periodi- plained, sudden or dramatic change in your spas- cally for pump refi lls (done by injecting baclofen ticity level may sometimes signal a problem, so let through the skin into the pump reservoir).
your health care provider know immediately.
Mechanical problems with the device may occur and could result in a baclofen overdose or under- Our health information content is based on research evi-dence whenever available and represents the consensus of dose. For this reason, it is important for you to expert opinion of the SCI Model System directors.
understand the risks, monitor yourself carefully, and get regular follow-up from your provider.
Spasticity and Spinal Cord Injury was developed by Maria R.  Other Surgery
Reyes, MD and Anthony Chiodo, MD, in collaboration with Other surgical treatments for spasticity are far the Model Systems Knowledge Translation Center.
Portions of this document were adapted from materials devel- Spinal Cord Injury Model Systems Consumer Information less commonly performed because they are not
reversible. These include cutting a section of the oped by the University of Michigan and UAB Model Systems.
spinal cord (myelotomy) or nerve roots (rhizoto- my), or lengthening and transposing a tendon. Your This information is not meant to replace the advice from doctor will discuss these surgical options with you a medical professional. You should consult your health care provider regarding specifi c medical concerns or treatment.

Source: http://www.biaoregon.org/docetc/publications/SCI/sci_spasticity.pdf