definition, clinical features, pathophysiology, assessment, treatment

1. SPASTICITY
PRATIGYA DEUJA

2. DEFINITION
Spasticity is defined as velocity dependent
increase in muscle tone with exaggerated tendon
jerks, resulting from hyperexcitabilty of the
stretch reflex i.e, the faster the passive
movements of the limb through it’s range, the
greater the increase in muscle tone.
Increased resistance to passive movements in
one direction.
It is an upper motor lesion.
It is noted in cases like; SCI, multiple sclerosis,,
traumatic brain injury, amyotrophic lateral
sclerosis, cp, spinal cord tumors.

3. CLASSIFICATION ACCORDINGTO
SEVERITY
1. MILD SPASTICITY:
 Clonus or mild increase in tone.
 No or minimal loss of range.
 Mild spasms; generally not problematic or
affecting function but annoying or
inconvenient

4. CLASSIFICATION cont..
2. MODERATE SPASTICITY:
 Loss of range of movement and possible
contracture.
 Walking is often effortful, may require aid
or wheelchair.
 Difficulty releasing grip or in hand hygiene.
 Minor adaptations required for position in
lying; t-roll, wedge, pillows, lumbar roll.

5. CLASSIFICATION cont…
3. SEVERE SPASTICITY:
 Marked increase in tone.
 Loss of range and probable contracture.
 Often hoisted for transfers.
 Difficult positioning despite complex seating
systems.
 Often reliant on a catheter and regular
enemas.

6. CLINICAL FEATURES
 Increasing tightness
 Worsening spasm
 Physical activities like; walking, transferring are
affected
 Functional activities like picking, grasping are
affected

7. PHYSICAL EXAMINATION
Positive signs: Negative signs:
o Hyperreflexia
o Babinski responses
o clonus
o Fatigue
o Reduced motor control
o Loss of coordination
o Muscle weakness

8. PATHOPHYSIOLOGY
 Spasticity resulted from a loss of descending,
facilitatory inhibitory influences that act on Ia
interneuron inhibition.
 Reciprocal inhibition mediated through Ia
interneuron requires facilitation from higher
centers. With injury to CNS the interneuron is
unable to shut off antagonist muscle firing with
resultant increased velocity dependent
resistance to movement.

9. PATHOPHYSIOLOGY
 The combination of both decrease inhibition,
increased depolarization state of cell membrane,
decrease action potential threshold for nerve
signal conduction thus increase activity of
structures innervated by the affected nerves.
 Recent studies suggest that intrinsic changes in
the motor neurone develop over time following a
lesion. These result in abnormally long plateau
like potentials that prolong motor neurone
discharge and thus muscle contraction in
response to synaptic inputs.

10. ASSESSMENT
 Patient history
 DTR
 Range of motion
 Test for clonus
 Functional observation
 Aggravating factors
 Modified Ashworth scale

11. MODIFIED ASHWORTH ScALE
 0 – No increase in muscle tone
 1 – Slight increase in muscle tone, manifested by
a catch and release or by minimal resistance at
the end range of motion when the part is
moved in flexion or extension/ abduction or
adduction
 1+ - Slight increase in muscle tone, manifested
by a catch, followed by a minimal resistance
throughout the remainder (less than half) of the
range of motion

12. MODIFIED ASHWORTH ScALE
2 – More marked increase in muscle tone
through most of the range of motion, but the
affected part is easily moved.
3 – Considerable increase in muscle tone, passive
movement is difficult
4 – Affected part is rigid in flexion or extension /
abduction or adduction

13. PHARMACOLOGICAL MANAGEMENT
 Baclofen
 Tizanidine
 Dentrolene
 Phenol block
 Botulinum toxin

14. SURGICAL MANAGEMENT
 Baclofen pump
 Tendon lengthening
 Tendon transfer
 Osteotomy
 Arthodesis

15. PHYSIOTHERAPY MANAGEMENT
 Positioning
 Ultrasound: 10 minutes/session
: Continuous mode for 5 weeks
: frequency : 1 mhz
: intensity : 1.5 w/cm2
 Cryotherapay : 20 minutes
 Thermotherapy : 20 minutes, prior to stretching
 Hydrotherapy
 Proprioceptive neuromuscular facilitation

16. PHYSIOTHERAPY MANAGEMENT
 Massage
 Passive movements
 Weight bearing through affected extremity
 Rood’s technique
 Yoga
 Relaxation techniques