Spasticity is a muscle control disorder that is characterized by tight or stiff muscles and an inability to control those muscles. In addition, reflexes may persist for too long and may be too strong (hyperactive reflexes). For example,an infant with a hyperactive grasp reflex may keep his or her hand in a tight fist.
Spasticity is found in conditions where the brain and/or spinal cord are damaged or fail to develop normally; these include cerebral palsy, multiple sclerosis, spinal cord injury and acquired brain injury including stroke.Damage to the CNS as a result of stroke or spinal cord injury, alter the peripheral nerves in the affected region. This change in input to bodily structures tends to favor excitation and therefore increase nerve excitability.
There are several types of treatment available which must be evaluated on a case-by-case basis, depending on the underlying cause, age of the patient, and severity of the spasticity. Different treatments share the common goals of:
- Relieving the signs and symptoms of spasticity.
- Reducing the pain and frequency of muscle contractions.
- Improving gait, hygiene, activities of daily living, and ease of care.
- Reducing caregiver challenges such as dressing, feeding, transport, and bathing
- Improving voluntary motor functions involving objects such as reaching for, grasping, moving, and releasing
- Enabling more normal muscle growth in children
Spasticity may be as mild as the feeling of tightness in muscles or may be severe enough to produce painful, uncontrollable spasms of the extremities; most commonly the legs and arms. Spasticity may also create feelings of pain or tightness in and around joints, and can cause low back pain.
Selective dorsal rhizotomy (SDR) is used primarily to treat children with lower-extremity spasticity, also known as spastic diplegia or diparesis. The primary goal of SDR is to reduce spasticity and to improve lower-extremity function. Patients who ultimately benefit most from the procedure typically have pure spasticity involving the lower limbs, good cognitive function and strength, no fixed contractures, and postural stability.Although the procedure has been successful in adolescents and even young adults, it is generally performed in a younger population (aged 3-8 years).
Patients with spastic quadriparesis (all 4 extremities involved) also benefit from SDR, but improvements in the upper extremities are typically less predictable and dramatic than those seen in the lower extremities. If a child with spastic quadriparesis has a significant component of dystonia, however, SDR may not be the best treatment option, and other modalities, including intrathecal baclofen, should be considered.
The benefits of surgery should always be weighed carefully against its risks. Randomized, controlled clinical trials have demonstrated that a large percentage of CP patients report significant reduction in spasticity and improved function after surgery. However, surgery is not an option for all cases of spasticity.
The expected result of spesticity is significant advances in spinal cord injury research have been in the field of neurorehabilitation. Neurorehabilitation uses physical therapy exercises to improve mobility and, when initiated soon after injury.
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