Treatment for Stroke-Related Spasticity
After a stroke, the injury to the brain can cause muscles to contract or flex on their own when you try to use an arm or leg. The sensation can be painful. It has been described as a "wicked charley horse." Because the muscle cannot move in its full range of motion, the tendons and soft tissue surrounding the muscle can tighten or become shorter. If not treated, spasticity can cause the muscle to "freeze" into an abnormal position, which can be very painful.
In the arm, spasticity can cause a balled-up fist, a bent elbow, or an arm pressed to the chest. Spasticity in the leg can cause a pointed foot, a curling toe, or a stiff knee. Spasticity can have a profound effect on the quality of life, making it difficult to walk or do daily activities.
Exercise and stretching are important treatments for spasticity. Therapists will work with you to increase your range of motion and help prevent permanent muscle shortening. You need to move the affected limb over and over again, either on your own or with the help of a therapist or a special machine.
If the joints of your affected limb are not moved through their full range of motion, they can become stiff to the point that they can no longer be straightened. Here are some tips to prevent stiff joints:
- Change your position every 1 to 2 hours during the day.
- Position your affected arm or leg to keep its mobility. For example, put a rolled washcloth in your hand to prevent hand stiffness.
- Exercise all your joints at least twice each day.
- Do not allow your affected arm or leg to be under your body when you are lying down.
- Do not allow your affected arm or leg to fall off the side of your bed or the wheelchair.
In some cases electrical stimulation is used on muscles. Casts or splints may be used to hold muscles in their normal position. This helps to prevent the muscles from shortening so it can work normally.
For many years, oral medicines that help prevent spasms (antispasmodics), such as baclofen, dantrolene (Dantrium), and tizanidine (Zanaflex), have been used to treat spasticity from stroke. These medicines relax tight muscles and stop muscle spasms. But they cause sleepiness and weakness and in some cases can cause hallucinations and sleep problems.
Botulinum toxin or phenol injections directly into the spastic muscle block messages that cause the muscle to contract.
Intrathecal baclofen is the same medicine that is used orally, but in this case, the medicine is delivered directly to the spinal cord through a small tube. The tube is implanted into the spinal cord by a surgeon, who also implants a small pump under the skin of the person's abdomen to deliver the medicine. Because the medicine is so targeted, the problems with sleepiness are avoided. This therapy is used mostly for people who have severe spasticity.
Some people may need surgery to treat spasticity. For example, surgery may be needed to lengthen or release muscles that are too tight in the arm or leg. Surgery may also be able to help someone regain movement in muscles that are weak or paralyzed.
Other Works Consulted
- Bates B, et al. (2010). Veterans Affairs/Department of Defense clinical practice guideline: Management of stroke rehabilitation. Available online: http://www.healthquality.va.gov/Management_of_Stroke_Rehabilitation.asp.
- Winstein CJ, et al. (2016). Guidelines for adult stroke rehabilitation and recovery: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, published online May 4, 2016. DOI: 10.1161/STR.0000000000000098. Accessed June 3, 2016.