Increased Muscle Spasticity After Traumatic Brain Injury
Brian D. Greenwald, MD
I'm a case manager and have gotten questions from patients and their families about TBI and spasticity — like how often is spasticity a problem and how is it best to treat spasticity that follows a TBI? I haven't been able to find any definitive research. Any ideas?
Before we talk about the treatment of spasticity, I think we should talk about
what is spasticity. So, after a central nervous system injury, an injury to either the brain
or the spinal cord, we see--it's not unusual to see an increase in tone, an increase
in resistance of the muscles as you try to move them. The severity of this problem
can be from mild to severe, so the treatment of it then varies also depending on
the severity of the problem. The problem can be seen in actually any of the muscles
throughout the body starting from the tongue right straight down to the ankles and
the feet. And so again you're looking at the treatment of the problem dependent on where
the problem is and the severity of the problem. There is a variety of treatments that you
can use for spasticity. Generally treatment is started by doing range of motion
and stretching and bracing--usually the early treatments for spasticity.
If that's not effective, there are a number of medications that can be used.
Medications are generally helpful for mild to moderate spasticity and are often
not as effective with more severe spasticity. In more severe spasticity,
botulinum toxin injections can be useful, and in even more severe spasticity from there
baclofen pumps are sometimes considered where actually a pump is implanted
into the person that sends baclofen, a spasticity medication, a fluid, into their
spine itself to help relax the muscles. After traumatic brain injury,
spasticity is found in about 25% of the patients early on and in about 10% of the
patients later on in the community.
Early on, when people have spasticity it can be a transient thing that we see in
patients after brain injury, and spasticity plays a small role later on.
There are a group of patients, as I say, about 10% of the patients who have ongoing needs
for treatment of their spasticity. And usually it's a combination of physical therapy techniques,
stretching, injections, medications, and sometimes this baclofen pump
that we were talking about in more severe cases.
Show transcript | Print transcript
Brian D. Greenwald, MD, Dr. Brian Greenwald is medical director of Center for Head Injuries and the associate medical director of JFK Johnson Rehabilitation Institute. He is a clinical associate professor in the Department of Physical Medicine and Rehabilitation at UMDNJ-Robert Wood Johnson Medical School.
The contents of BrainLine (the “Web Site”), such as text, graphics, images, information obtained from the Web Site’s licensors and/or consultants, and other material contained on the Web Site (collectively, the “Content”) are for informational purposes only. The Content is not intended to be a substitute for medical, legal, or other professional advice, diagnosis, or treatment.
Specifically, with regards to medical issues, always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on the Web Site. If you think you may have a medical emergency, call your doctor or 911 immediately. The Web Site does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the Web Site. Reliance on any information provided by the Web Site or by employees, volunteers or contractors or others associated with the Web Site and/or other visitors to the Web Site is solely at your own risk.