Spasticity

What kinds of symptoms will I see in my loved one?

Your loved one may experience tightness of their muscles or have uncontrolled spasms. This can affect the range of motion in your loved one’s neck, body, arms, and legs. If not treated, spasticity symptoms can lead to poor body positioning, which can cause discomfort or pain.
 
Over time, uncontrolled spasticity can cause muscles to become permanently shortened, forming a contracture. A contracture is the loss of range of motion in a joint where the joint can no longer be moved, or movement is extremely minimal.
 
Muscles that remain contracted and resist stretching affect the movement of the neck, trunk, arms, and legs. Once contractures set in, functions such as swallowing, walking, and completing personal hygiene may be affected. 

What treatments are available?

Initial treatments for spasticity include stretching, the use of splints and braces, and medications. See below for more information on why these treatments might be helpful. 
 
Disclaimer: The techniques listed are individualized to each patient, and the recommended approach may look different based on the facility you are in, the clinician you are working with, and the level of your loved one’s needs. Some methods used include a specialized approach to help with neurologic recovery. If you have not had training on the techniques shown below, please seek out assistance from a trained professional to prevent injury.

What medications can be used to treat spasticity?

Medications can be used to treat spasticity in patients who do not respond to stretching and bracing. Medications can be used to help with pain due to spasticity or in cases where spasticity interferes with providing care. The medications listed below are FDA-approved but have not been specifically studied in people with DoC.

• Dantrolene
  Dantrolene directly relaxes the muscle without causing sedation. Blood work is usually checked with this medication to make sure the liver stays healthy.
• Baclofen - oral or through feeding tube
  Baclofen is usually given as a pill to help relax the muscles. Sedation is a limiting side effect of oral baclofen. Overdose of baclofen can cause sedation, respiratory failure, seizures, hallucinations, nausea, and vomiting. This medication must be weaned as withdrawal is life-threatening.
• Baclofen - pump
  Baclofen can be given through an implantable pump for patients with severe spasticity not helped by other medications. The pump is typically placed in the abdomen, and a small catheter carries the medication directly to the fluid around the spinal cord. Patients usually have fewer side effects with baclofen in the pump than with oral baclofen. The pump needs to be refilled by a physician every one to six months based on the dose, and the pump needs to be replaced every seven years. Baclofen withdrawal symptoms can still occur in the case of pump failure.
  
  Intrathecal Baclofen Pump: How It May Help Spasticity
  From Flint Rehab
• Tizanidine
  Tizanidine can be used to decrease spasticity and help with muscle pain. Side effects include sedation, low heart rate, and low blood pressure. There are multiple medications with which tizanidine can interact, so make sure you alert your physician if on this medication.
• Botulinum toxin injection (Botox)
  The medicine is injected into individual muscles by a physician, allowing for treatment in that specific muscle group without side effects throughout the whole body. Relaxation of the muscle begins two days after injection with maximal effect starting at two weeks. It lasts for three months, requiring repeat injections at that time.
• Phenol 
  Phenol is a chemical like alcohol. Injection of phenol near a nerve will decrease the nerve activity and decrease spasticity in a group of muscles. This injection can damage the nerve and cause abnormal sensations. It is usually reserved for severe spasticity in a group of muscles that is not responsive to other treatments.

When using medications for spasticity and the treatment of pain and/or developing contractures, side effects should be monitored. When it comes to medications, balancing the recovery process of wakefulness with improving the spasticity and/or pain should also be taken into consideration. Healthcare providers start by using lower doses of medicines with lower sedation side effects, and then they increase doses and/or add new medicines gradually. Treatments involving injections and pumps are usually indicated after other measures like splints, casts, and medications have been in use and proved less effective than had been expected. Each person with a brain injury and spasticity requires a very individualized treatment plan and management of medications. Severe side effects can occur if these medications are suddenly discontinued. Talk with your medical team if you have any questions about the medications for your loved one's spasticity.

What do I do when my loved one has pain from spasticity?

If you feel your loved one may benefit from a range-of-motion program to keep muscles and joints moving and to reduce discomfort or pain caused by spasticity, or you would like to learn how to perform these exercises, please consult with your treatment team or healthcare provider.
 
After you have been trained to perform range-of-motion exercises for your loved one and you notice a new response to discomfort or pain, please consult with your therapy team or healthcare provider for concerns and guidance on how to best modify your approach to stretching.