A. Problem Specifics
Spasticity is the state of increased tone of a muscle and an increase in the deep tendon reflexes. For example, with spasticity of the legs (spastic paraplegia), there is an increase in tone of the leg muscles so they feel tight and rigid and the “knee-jerk” reflex is exaggerated. It does not occur immediately following a spinal cord injury. When an injury occurs to the spinal cord, the body goes into spinal shock that may last several weeks. During this time, changes take place to the nerve cells that control muscle activity. This affliction is most common in patients with MS (Multiple Sclerosis) and other auto-immune diseases such as Lupus and Rheumatoid Arthritis.
Following a spinal cord injury, the nerve cells below the level of injury become disconnected from the brain at this level. This is due to scar tissue that forms in the structure of the damaged area of the spinal cord thus blocking messages from below this level of injury from reaching the brain.
B. Causes and Symptoms
Once spinal shock wears off, the natural reflex that is present in everyone re-appears. Spasticity is an exaggeration of the normal reflexes that occur when the body is stimulated. In an able-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, a signal that is inhibitory is sent along the spinal cord canceling the reflex from moving the muscle. In a person with a spinal cord injury (or given someone with MS), this inhibitory signal is blocked by the structural damage in the spinal cord and thus, the natural reflex is allowed to continue resulting in a contraction of the muscle. This is how spasticity is born.
Muscle spasms and/or spasticity 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 at this level. 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. However, there are specific conditions that can make it more of a problem. An infection of the kidneys or bladder 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, the muscles and joints become less flexible and almost any minor stimulation can cause severe spasticity.
C. What To Do About Spasticity and/or Muscle Spasms
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 will also reduce spasticity. There are three primary medications used to treat spasticity – Baclofen, Valium, and Dantrium. All have some side effects and do not completely eliminate the problem.
Another treatment of severe spasticity is the implantation of a Baclofen pump. The pump delivers a pro-grammable amount of Baclofen directly to the fluid surrounding the spinal cord. The drug then inhibits the reflex signal in the reflex arch of the cord stopping stimulation of the muscle to spasm.
Because the drug is delivered directly to the spinal cord, a very small amount can be used in comparison to a large amount that may have to be taken orally. Once a Baclofen pump is implanted, oral anti-spasmodic drugs are usually stopped.
D. Cautions with Solutions
Surprisingly, 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 present by the increase in muscle spasms. Spasticity also helps to maintain muscle size and bone strength. It does not replace walking but it does help to preventing osteoporosis, to a minor degree. 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.
A surgical procedure called “radio-frequency rhizotomy” is sometimes indicated in the treatment of severe spasticity in which spinal nerves are cut in order to relieve pain or high blood pressure. Spasticity targets and destroys the damaged nerves that do not receive “Gamma-Amino-Butyric-Acid (GABA)”, the core of the problem for people with MS, spastic cerebral-palsy and other related maladies. In this case where the nerves which, due to not receiving GABA and are, therefore, generating unusual electrical activity, are cut with the remaining nerves and nerve routes carrying the correct messages, as they were and fully intact.
This is best done in the younger years before bone and joint deformities take place before the pull of spas-ticity. However, it can, as well, still be performed safely and effectively on adults. This is a permanent pro-cedure that addresses the spasticity at its “neuromuscular” root; i.e., in the central nervous system that contains the misfiring nerves that cause the spasticity of those certain muscles in the first place. After this type of procedure, assuming no complications, the person’s spasticity is usually completely eliminated, revealing the “real” strength (or lack, thereof) of the muscles underneath.
Because the muscles may have been depending on the spasticity to function, there is almost always extreme weakness after such a “rhizotomy-procedure”. The result requires the patient to work very hard to strength-en the now-weak muscles with intensive physical therapy and to learn new habits of movement and daily tasks in a “new” a body without the spasticity. Rhizotomy’s result is fundamentally, not like orthopedic surgical procedures where any release in spasticity is essentially rewarding but temporary.
There is a support group forum, designed for families, users and potential users of the Baclofen pump, to control spasticity. They are called the Intrathecal Baclofen Therapy Discussion Board Forum.
The Synchro-Med 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. They are reached at http://www.medtronic.com – The SynchroMed Pump.
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 reached at http://www.codman.com.