Spasticity: Everything you need to know!

What is spasticity?

Spasticity is characterized by reflex muscle contractions, resulting in stiffness during stretching, typically present in muscles with motor deficits.

Spasticity varies greatly in its onset. Symptoms can vary in intensity and occur both day and night, significantly impacting the quality of sleep for those affected.

This symptom is caused by the alteration of nerve conduction, meaning there is a problem in the "transport" of nerve information by the nerve.

It leads to an increase in muscle tone, manifested by:

• Persistent stiffness,
• Contractures,
• Painful spasms that can become disabling.

Spasticity is commonly found in conditions such as multiple sclerosis (MS), stroke (CVA), tetraplegia, brain or spinal cord damage (tumor, infections, etc.), cerebral palsy, or after a head injury.

Other factors known as irritative stimuli, or aggravating factors (fever, stress, pressure sores, urinary and dental infections, etc.), can significantly impact the level of spasticity in a patient.

What is the impact of spasticity on patients' quality of life?

The main consequences of spasticity are increased muscle tone and heightened osteotendinous reflexes. This can significantly affect patients by causing issues such as:

• Spasms
• Contractures
• Abnormal physical posture
• Pain

Additionally, spasticity can lead to motor disturbances and a loss of dexterity in the fingers. It complicates movement, posture maintenance, balance, transitioning between sitting and standing, dressing, and other daily activities.

How is spasticity diagnosed?

Healthcare professionals use different scales to assess the intensity of spasticity and propose the most appropriate management for the patient.

A physiotherapist or rehabilitation doctor, by rapidly moving the leg or arm, for instance, can check for resistance, which is indicative of spasticity.

Using a scale from 0 (no spasticity) to 5 (severe spasticity), they can measure the degree of spasticity and adjust the treatment plan accordingly.

Another scale, reflecting the patient's perspective, is also used. This is called the "Numerical Rating Scale," where patients rate their spasticity intensity from 0 to 10.

Both analyses are important as results can differ. The patient's perception might be higher than the doctor's assessment, and spasticity can vary greatly throughout the day.

How is spasticity managed?

Non-drug treatments

Physiotherapy aims to reduce muscle tone and improve the range and coordination of movements through postures and stretches. The physiotherapist stretches the spastic muscles and teaches the patient self-stretching exercises, which are effective and significantly improve quality of life when practiced daily.

Occupational therapy helps patients gain autonomy in their daily lives by proposing solutions to adapt to their new constraints.

Cold therapy is effective for patients whose spasticity symptoms worsen with heat. It is recommended to apply crushed ice wrapped in a cloth to the affected areas to reduce body temperature by about 1 degree.

Stress management techniques like sophrology or meditation help manage stress and negative emotions, which can impact spasticity.

Drug treatments

Muscle relaxants can be prescribed in gradually increasing doses, as their effectiveness and tolerance vary among patients.

Intramuscular injections of botulinum toxin can locally reduce muscle activity.

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