Spinal Cord Injury Spasticity and Muscle Spasms

Contents

Spasticity Following a Spinal Cord Injury

Following a spinal cord injury the nerve cells below the level of injury become disconnected from the brain at the level of injury. This is due to scar tissue which forms in the structure of the damaged area of the spinal cord, blocking messages from below the level of injury reaching the brain. Spasticity does not occur immediately following a spinal cord injury. When an injury occurs to the spinal cord the body goes into spinal shock, which may last several weeks. During this time changes take place to the nerve cells which control muscle activity.

Once spinal shock wears off, the natural reflex which is present in everyone reappears. Spasticity is an exaggeration of the normal reflexes that occur when the body is stimulated in certain ways. In an abled bodied person, a stimulus to the skin is sensed, and a sensory signal is sent to the reflex arch where it travels to the brain via the spinal cord, the brain then assesses the stimulant, and if the stimulant is thought not to be dangerous, an inhibitory signal is sent down the spinal cord, and cancels the reflex from moving the muscle.

In a person with a spinal cord injury this inhibitory signal is blocked by the structural damage in the cord, and the natural reflex is allowed to continue resulting in a contraction of the muscle.

Triggering of Spasticity

Muscle spasms can occur in a person with a spinal cord injury any time the body is stimulated below the level of injury. This is usually noticeable when a muscle is stretched, or there is a painful stimulant below the level of injury. Because of the injury to the spinal cord, these sensations can trigger the reflex resulting in the muscle to contract or spasm.

Almost anything can trigger spasticity. Some things, however, can make spasticity more of a problem. A bladder infection or kidney infection will often cause spasticity to increase a great deal. A skin breakdown will also increase spasms. In a person who does not perform regular range of motion exercises, muscles and joints become less flexible and almost any minor stimulation can cause severe spasticity.

Some spasticity may always be present. The best way to manage or reduce excessive spasms is to perform a daily range of motion exercise program. Avoiding situations such as bladder infections, skin breakdowns, or injuries to the feet and legs may also help to control spasticity. There are four primary medications used to treat spasticity, baclofen, diazepam (Valium), dantrolene (Dantrium) and tizanidine (zanaflex). All have some side effects and do not completely eliminate spasticity.

Benefits of Spasticity

There are some benefits to spasticity. It can serve as a warning mechanism to identify pain or problems in areas where there is no sensation. Many people know when a urinary tract infection is coming on by the increase in muscle spasms. Spasticity is also an advantage to help maintain muscle size and bone strength. It does not replace walking, but it does help to some degree in preventing osteoporosis. Spasticity helps maintain circulation in the legs and can be used to improve certain functional activities such as performing transfers or walking with braces. For these reasons, treatment is usually started only when spasticity interferes with sleep or limits an individual's functional capacity.

Surgical Intervention of Spasticity

A surgical procedure called a radio-frequency rhizotomy is sometimes indicated in the treatment of severe spasticity. Another treatment of severe Spasticity is the implantation of a Baclofen Pump. The pump delivers a programmable amount of baclofen directly to the fluid surrounding the spinal cord. The drug inhibits the reflex signal in the reflex arch of the cord and therefore inhibiting muscle spasm. Because the drug is delivered directly to the spinal cord, a very small amount can be used in comparison to a large amount which may have to be taken orally. Once a baclofen pump is implanted, oral antispasmodic drugs are usually stopped.

Further Information on Spasticity Post Spinal Cord Injury

Intrathecal Baclofen Therapy Discussion Board Forum. This is a support group forum designed for families and users and potential users of the Baclofen pump to control spasticity.

Intrathecal Baclofen Therapy and Spasticity Studies and Research. The following information has been gathered about Intrathecal Baclofen Therapy and the use of the baclofen pump in treating severe muscle spasms to improve the quality of life in patients.

www.medtronic.com - The SynchroMed Pump. The SynchroMed pump is an implantable, programmable, battery-powered device that stores and delivers medication according to instructions received from the programmer. The primary differences between the pump models are the size of the reservoir and the presence of a side catheter access port.

www.codman.com - The CODMAN 3000 Infusion Pump is a cost-effective therapy for those patients that fail conventional medical treatment. This elegantly simple device features an inexhaustible power supply, and does not require frequent replacements associated with battery powered pumps. Codman is part of the Johnson & Johnson Family of Companies.

  • Showing the pathways from the sensory nervous system via the reflex synapse in the spinal cord back down through the motor nervous system which invokes a reflexive spasm.

    Showing the pathways from the sensory nervous system via the reflex synapse in the spinal cord back down through the motor nervous system which invokes a reflexive spasm.