Spasticity and Stroke

Stroke and Brain Function

A stroke is caused by either a blockage of a blood vessel or bleeding in or around the brain, which results in a lack of oxygen to the brain and the death of brain cells.

In the simplest terms the brain receives messages, process messages, and sends messages. Each area of the brain is responsible for different things. Depending on the area of the brain that was damaged will determine which messages are interrupted.

If the area of the brain that was damaged was the signal to send a message to your bicep and/or tricep muscles (the muscles that bend and straighten your elbow), you might experience tightness of those muscles due to spasticity.

What is Spasticity?

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Spasticity is essentially a reflex. Reflexes are our bodies way of protecting ourselves. When we touch a hot stove with our hand, our muscles immediately contract to move our hand out of harms way. This message is not actually coming from the brain. It would take too long for the signal to go from the skin to the brain, process it, and send a signal back to the muscle to move away from the hot object. The pain message from the skin goes to the spinal cord and sends a signal right away to the muscle to contract. Once the hand is moved away from the harmful surface the brain has had enough time to process if it is safe for the muscle to relax, and is able to send a signal to relax the muscle.

In it's truest definition, spasticity occurs in response to quick movement: if your elbow is quickly extended, it will pull into flexion. This reaction is a symptom that the brain to muscle messaging system is impaired. But spasticity and increased tone are also used as general terms to describe any tightness of muscles that result from damage to the brain or spinal cord. Meaning when the tightness of a muscle occurs without the quick stretch, such as posturing the arm in flexion or a muscle tightening during an activity, this is often referred to as spasticity as well.

What happens after a stroke is that the brain has difficulty sending a signal to the muscle to relax. Sometimes the message is absent and there is no active signal and sometimes the message to relax is weak. This is why some people might tighten when they are running or during an activity. Their brain is working hard on sending signals to the rest of the body, it doesn't have the time to work on sending a signal to relax the muscle.

Managing Spasticity

It’s important to note that not all spasticity is bad. Many people with stroke use their spasticity to assist with standing, transfers, and daily activities. It’s important to discuss options for managing spasticity and functional implications with your physician and your occupational or physical therapist.

There are two general approaches that address spasticity: medical management and physical management. Medical management is decided in collaboration with the patient and physician. It addresses the neural component that is causing the muscle tightness. Medical management of spasticity includes oral medications, neurotoxin or phenol injections, and surgical interventions.

The physical management is typically addressed by a physical or occupational therapist and addresses the biomechanics of the joint to prevent muscle shortening, joint deformities, and decreased function. Physical management includes stretching, muscle strengthening, and intensive repetitions. Physical and occupational therapists also use electrical stimulation and ice as modalities to limit spasticity during exercise or functional activity.

STRETCHING

Spasticity tightens our muscles and over time the muscle begins to shorten. This limits our ability to move our joints even further. Stretching has the potential to quiet the hyper exaggerated reflex for several hours, as well as the benefit of maintaining range of motion. Stretches should be held for 30 seconds or more and you may feel a release of the muscle tone.

Splinting and orthotics are used for an even longer stretch. They position a joint optimally to maintain length of a muscle and prevent contractures. Depending on the purpose, splints and orthotics are worn during the day or at night to allow for hours of stretch time.

Weight-bearing is a form of prolonged stretching with the added benefits of strengthening and increasing bone density. After a stroke the motor function of the leg tends to return before the arm, and one of the reasons may be the motivation to walk and the intensive weight bearing of the leg. When we weight bear or put pressure on our muscles and joints, we are sending signals to the brain. The brain is getting a lot of feedback from that extremity. Any weight bearing of the upper extremity either at the wall, table, or floor helps sends signals to the brain that reminds it the arm is still there.

STRENGTHENING

Strengthening can improve spasticity in two ways. By strengthening the antagonist (opposing) muscle, it can help inhibit the reaction of the spastic muscle. When the spastic muscle activates and tries to pull a joint into flexion, the extensor muscle has the capacity to limit the flexion just by being stronger.

We must also strengthen the spastic muscle. It might seem that with all that contracting a spastic muscle would be a strong muscle, but without the brain to muscle connection a spastic muscle is actually a weak muscle. Utilizing electrical stimulation or ice prior to strengthening a spastic muscle may be a way to optimize your strengthening session.

Strengthening can happen any time a muscle is contracted, but depends on the capability of the person doing the contracting. It has to be somewhat difficult. The muscle has to fatigue. The person who does not have full active range of motion, but is able to visibly contract a muscle is strengthening with each repetition of movement.

Repetition of movement is a rehabilitation strategy not only for strengthening, but plasticity. Intensive repetitive training or massed practice is the key to neuroplasticity and improving the way the brain sends signals to the muscles.

INTENSIVE REPETITIVE TRAINING

Voluntary movement has the potential to maintain joint range of motion, strengthen, and increase plasticity. But it’s all about repetition. In a typical therapy session, you might expect to do 20-30 repetitions of movement. You would be responsible for completing the movements for each joint on a daily basis. This can become boring and the habit slowly slips away.

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The NEOFECT Smart Glove and Smart Board fit right into the gap of what we know therapeutically and what is actually happening on a day to day basis. The NEOFECT Smart Glove and Smart Board turn your home program into a fun and motivating way to maintain range of motion, strengthen, and optimize your functional outcomes.

Every person is unique and has a different rehabilitation journey. Neofect has experienced occupational therapists to consult with to see what might work for you.

If you've had a stroke and are looking for an effective solution for your rehabilitation needs, please look into NEOFECT's line of Smart Rehabilitation Solutions.

To learn more, please call (866) 534-4989 or email contactus@neofect.com.

For more information on stasticity and stroke:
American Association of Neurosugical Surgeons - Spasticity
National Institute of Neurological Disorders and Stroke - Spasticity Information Page
Cleveland Clinic - Spasticity

National Stroke Association - What is Stroke
Mayo Clinic - Stroke Symptoms and Causes
Stroke Association - About Stroke

All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the NEOFECT website is solely at your own risk.

Clarice Torrey
Clinical Manager / Occupational Therapist

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