Understanding and Managing Muscle Spasticity in Neurological Disorders

Muscle spasticity (or excessive tone, spasm or clonus), is characterised by excessively tense muscles or muscles that spasm or move without us trying to move them. It is commonly associated with neurological disorders such as multiple sclerosis, stroke or spinal cord injury. This can have an adverse effect on the lives of people who experience it. Its effects can include discomfort, restrictions in joint motion and mobility, restricted gait, difficulty transferring from a wheelchair, muscle contractures (stiffening of the muscles), or uncomfortable/embarrassing joint movements in everyday life. Many of our NDIS clients may experience some of these issues. We will review some of the management strategies discussed in an article from the Journal of Practical Neurology (Kheder and Nair, 2012).

Goals/Expectations

When creating a management plan, it is important to consider realistic goals and expectations about your condition, these can be discussed with your doctor alongside professionals such as occupational therapists, physiotherapists and exercise physiologists. Often these management types are used in conjunction with each other.

Specific goals might include:

  • Reduced pain or discomfort
  • Improved skincare to reduce pressure ulcers
  • Improved sleeping
  • Improved chair posture/transfers
  • Improved gait

Medication

Once again your medication choice should be determined by your goals. Some of the common anti-spasticity medication/treatments include: Baclofen, Benzodiazepines and Botulinum toxin injections. Your doctor will discuss the right treatment with you, depending on your goals.

Physical interventions

Stretching:
Both self-stretching and assisted stretching aided by a therapist can aid in managing spasticity. Physiotherapist and Exercise Physiologists can assist you with assisted stretching or helping to create a self-stretching program.

Strengthening/mobility exercises:
Additionally, regular movement and weight bearing of both the muscles experiencing spasticity and the surrounding muscles can improve the mobility and range of motion of the affected joints. An Exercise Physiologist and Physiotherapist can help create a suitable strengthening and mobility program.

Splints:
Joint aids such as splints which help to keep a joint in a fixed position, can aid in spasticity management. Joints such as wrists or ankles often use these. A physiotherapist should be consulted for the correct splint recommendation.

Posture and standing devices:
Devices such as a ‘tilt table’ or ‘standing frame’ can aid someone in standing up, this can assist in stretching the joints while also receiving weight bearing and increased blood flow. This is great for preventing both maintaining bone density and reducing the prevalence of pressure ulcers. Occupational therapists can assist in recommending this equipment.

 

All of these management types can be used together to target your specific goals. They are often used in conjunction, such as utilizing physiotherapy and stretching following Botulinum Toxin injections. For many people their condition may also change over time, and their goals and treatment methods may also change over time. If you have a neurological disorder and are interested in improving the management of neurological symptoms such as spasticity, you should begin by consulting with your doctor.

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