Spasticity & Muscle Spasms
Spinal Cord Injury Spasticity Sections
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
Surgical Intervention of Spasticity
A surgical procedure called a radiofrequency 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 anti spasmodic drugs are usually stopped.
Further Information on Spasticity Post Spinal Cord Injury
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.
Baclofen Therapy and Spasticity Studies & 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.
- 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.
- 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
Support : Types
of Paralysis : Vertebral Column : Spinal
Cord : Myotomes & Dermatomes
Autonomic Dysreflexia : Spasticity
& Spasms : Temperature Regulation
: Respiratory System :
Pressure Sores : Spinal
Cord Injury Research