Post-stroke care management on spasticity

Muscle spasticity after stroke can cause muscles on the affected side of your body to become stiff and may lead to pain. After a stroke, about 1 in 3 survivors experiences spasticity. Learn more about spasticity and available treatments here.

What is Spasticity?

Our brain sends signals to the muscles to control movements. When this area of the brain is damaged after a stroke, the signals may be affected and can result in muscle stiffening, referred to as spasticity.

Spasticity may be as mild as feeling tightness in the muscles. For some it may be severe enough to produce painful, uncontrollable spasms of the legs and arms. It may also result in the fixed positions of joints, known as contractures.

Some examples of muscle spasticity in stroke survivors include having:

• A bent elbow
• A tight fist
• An Arm pressed against the chest
• Uncontrolled straightening of the leg and foot in a downward-pointing position

What are the effects of spasticity?

Spasticity is not always bad. It can help provide support to the affected limb during activity. However, severe spasticity usually limits movement and causes joint problems. Therefore, daily activities such as walking, bathing, eating and dressing may become difficult.

Spasticity can cause:

• Stiffness
• Muscle spasms
• Pain
• Contractures (joints becoming fixed in one position)
• Fatigue
• Mobility Issues

What are the options for treating spasticity? 

Here are some strategies and treatments for spasticity.

Physiotherapy and Occupational Therapy

Depending on the severity and area that is affected, your therapist will recommend appropriate exercises and other strategies to improve the quality of movement and the control of your muscles.

They include:

	Exercises, stretching and movement such as: Range of motion and strengthening exercises either actively or being assisted by someone Gentle stretching of stiff muscles Proper positioning of the affected upper and lower limbs Caring for the affected limb to prevent injury
	Provide advice to remain active Muscle stiffness may reduce with regular movement. Being sedentary can cause muscles to weaken and may contribute to the development of contractures. Thus, it is important to move as much as possible. Join an exercise group or ask your family and friends to help you practise doing things and moving more.
	Modifying daily activities Learning new ways of doing everyday tasks such as walking, bathing, dressing, and eating.
	Home modification To overcome physical limitations resulting from spasticity, changes to the home environment may be necessary. Examples are the use of grab bars, ramps, raised toilet seats and non-slip tiles on the toilet floor.
	Using appropriate aids and/or equipment Splints and gaiters may be used to maintain range of motion and improve joint positioning. Appropriate aids and equipment such as feeding aids, shower chairs/commodes, walking aids, and wheelchairs, allow you to participate in everyday activities with greater ease. It can also help you to move about freely as you regain strength.
	Functional Electrical Stimulation (FES) FES can be used to strengthen the affected muscles to relearn functions such as grasping, reaching and walking. This may be recommended by your      therapist after their assessment to determine appropriateness.

Medications

In certain cases, your doctor may prescribe medications through one of these routes:

Oral There are oral medications that may relieve spasticity such as Baclofen.

Injection Botulinum toxin therapy is more targeted and is used for localized treatment for spasticity. Botulinum Toxin is injected into the affected muscle directly, reducing the stiffness of that particular muscle. This may improve positioning and function. The effects usually take 7 to 10 days to become noticeable with effects lasting from 3 to 6 months. For maximal benefits, it is essential to combine botulinum toxin therapy with stretching and muscle strengthening exercises.

Surgery

There are surgical procedures available for treatment of soft tissue contractures resulting from spasticity. However, surgery is not an option for all. The benefits of surgery should always be carefully weighed against its risks.

To achieve the best results for you or your loved one, please seek advice from your doctor and healthcare professionals caring for you.

Article available Chinese, Malay and Tamil.

For more information on how to better manage your stroke recovery journey, visit Stroke E-Resources.

StrokeHub Video: 

Spasticity (Extended Version) https://youtu.be/4DL8Szm3w0s

Spasticity https://youtu.be/ebo7VyJtsJo