What is Spasticity?
Muscle tone is the term for the normal resistance to stretch in healthy muscles. We all have muscle tone. Spasticity is the medical word for an uncontrollable increase in muscle tone due to an injury to the brain or spinal cord. There are different levels of severity in tone that impact how much it is interfering in function, or sometimes it can help function.
What kinds of symptoms will I see in my loved one?
Your loved one may experience You may see some tightness of the muscles or have uncontrolled spasms. Uncontrolled muscle tone can lead to even more spasms. This can affect the range of motion in your loved one’s neck, body, arms, and legs. If not treated, symptoms can lead to poor positioning, which can cause discomfort or pain.
Uncontrolled muscle tone can lead to spasms and limited range of motion in the neck, trunk, arms, and legs. These symptoms can lead to poor positioning and may also 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.
Where can I learn more?
These resources will give you a more detailed explanation of what Spasticity is after a traumatic brain injury and how it can be managed.
Spasticity and Traumatic Brain Injury (PDFs available in English and Spanish)
From Model Systems Knowledge Translation Center
Spasticity (PDF)
From Shepherd Center
Increased Muscle Spasticity After Traumatic Brain Injury (video)
From BrainLine
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.
Splints
Splints are devices used to protect, stretch, or hold a body part in one place. Splint needs are individualized to each person with a brain injury. Examples of commonly used splints and braces can be found here:
- Splints and Braces (PDF)
From Shepherd Center
Bivalves
One type of splint used in positioning a person with a brain injury is called a Bivalve. A bivalve is a custom splint made from a fiberglass cast, that is cut in half to allow for long-term use. This allows the splint to be removed to monitor the tone and skin underneath. Bivalves can be used on arms or legs.
- Arm Bivalve – A customized arm splint that allows for long-term use with removal and/or monitoring of the skin underneath.
Short Arm Bivalve Application (video on Vimeo)
From Shepherd Center - Leg Bivalve – A customized leg splint that allows for long-term use with removal and/or monitoring of the skin underneath.
Ankle Bivalve Application (video on Vimeo)
From Shepherd Center
What do I do when there is a problem with my loved one’s splints?
Problems with splints or bivalves are noted by red marks or blisters found after removing them. Please consult with your therapy team or healthcare provider if you notice these issues. To troubleshoot splint and brace concerns, you can visit:
Troubleshooting Splints and Braces (PDF)
From Shepherd Center
If you feel your loved one may benefit from the use of a splint for positioning, please consult with your treatment team or healthcare provider.
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 despite 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, with 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 (injection)
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 then 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 tightness.
Range of Motion Exercises
Videos of examples of how to perform range of motion exercises on Vimeo:
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.