But spasticity and increased tone are also used as general terms to describe any tightness of muscles that result from damage to the brain or spinal cord. Meaning when the tightness of a muscle occurs without the quick stretch, such as posturing the arm in flexion or a muscle tightening during an activity, this is often referred to as spasticity as well.
What happens after a stroke is that the brain has difficulty sending a signal to the muscle to relax. Sometimes the message is absent and there is no active signal and sometimes the message to relax is weak. This is why some people might tighten when they are running or during an activity. Their brain is working hard on sending signals to the rest of the body, it doesn't have the time to work on sending a signal to relax the muscle.
Many people with stroke use their spasticity to assist with standing, transfers, and daily activities. There are two general approaches that address spasticity: medical management and physical management. Medical management is decided in collaboration with the patient and physician. It addresses the neural component that is causing the muscle tightness.
Medical management of spasticity includes oral medications, neurotoxin or phenol injections, and surgical interventions. The physical management is typically addressed by a physical or occupational therapist and addresses the biomechanics of the joint to prevent muscle shortening, joint deformities, and decreased function. Physical management includes stretching, muscle strengthening, and intensive repetitions. Physical and occupational therapists also use electrical stimulation and ice as modalities to limit spasticity during exercise or functional activity.
Spasticity tightens our muscles and over time the muscle begins to shorten. This limits our ability to move our joints even further. Stretching has the potential to quiet the hyper exaggerated reflex for several hours, as well as the benefit of maintaining range of motion.
Stretches should be held for 30 seconds or more and you may feel a release of the muscle tone. Splinting and orthotics are used for an even longer stretch. They position a joint optimally to maintain length of a muscle and prevent contractures. Depending on the purpose, splints and orthotics are worn during the day or at night to allow for hours of stretch time. Weight-bearing is a form of prolonged stretching with the added benefits of strengthening and increasing bone density.
After a stroke the motor function of the leg tends to return before the arm, and one of the reasons may be the motivation to walk and the intensive weight bearing of the leg. When we weight bear or put pressure on our muscles and joints, we are sending signals to the brain. The brain is getting a lot of feedback from that extremity. Any weight bearing of the upper extremity either at the wall, table, or floor helps sends signals to the brain that reminds it the arm is still there.
Question: Is botox or phenol therapy a good idea for a stroke survivor? Answer: Botox and phenol can be injected into specific muscles to reduce spasticity. This reduction in spasticity can be beneficial allowing increased range of motion for activities of daily living or potentially allowing for more active movement.
These treatments can be highly effective for some and less effective in others. A physician experienced with botox and phenol injections can determine if a stroke patient is a good candidate for these treatments. Adverse reactions to botox can include nausea, fatigue, bronchitis, muscle weakness and limb pain.
Botox has been approved by the FDA for treatment of spasticity in the elbow, wrist, and fingers in stroke patients specifically the flexor muscles.
Botox comes with a warning that it is produced from the same bacterium that causes botulism and has the potential to spread beyond the treated area and cause symptoms similar to botulism.
Question :My mother suffered from stroke following venous sinus thrombosis. She has recovered well and now the only problem area is her ankle, which is still spastic. Dorsiflexion at ankle is difficult and it goes into external rotation can you suggest some exercises to tackle that?
Answer : Ankle spasticity can be approached in several ways. Here is a list of treatments ranging from conservative in nature to surgical techniques: 1. Daily stretching - stretch the ankle into dorsiflexion until the point of discomfort and hold for 60 seconds. Repeat twice daily. Range of motion exercises - foot circles rotating the ankles one way then the other, raising the foot off the floor ankle dorsiflexion , rock back and forth on the toes then heels in a standing position support hands on wall , and trying to pick up objects such as marbles with the toes.
Perform 10 repetitions of each exercise twice daily. Equipment can be used to help with stretching and exercises such as a foot rocker. Electrical stimulation e-stim - this technique can be used on some patients as long as they don't have contraindications for use check with MD to see if patient is a candidate for e-stim. E-stim may help reduce spasticity as well as strengthen weak or spastic muscles. Splinting - an ankle foot orthoses AFO can be made to position the ankle and keep it on a static stretch.
Dynamic splinting splints allowing ankle motion and serial casting are also available. Medication - various medications can be administered by a MD to control spasticity. Examples of such medicines may include baclofen, dantrolen sodium, and Zanaflex. Nerve Blocking Injections - examples include phenol and botulinum toxin. ITB - Intrathecal Baclofen Pumps can be surgically placed to deliver baclofen into the subarachnoid space of the spinal cord to help reduce spasticity.
Surgery - One common surgery technique includes an anterior tibial transfer to help straighten and balance the foot. A more extreme surgery is a dorsal rhizotomy which involves disrupting the nerve supply to the muscle. Question : My 5 yr old had a stroke 8 mos ago. She has produced quite a bit of tone in her left hand sometimes making it difficult to open her hand, grab and release objects.
The OT said that once tone sets in you cannot get rid of it. Is this true? This is the first therapist that has told me this. Answer : I have seen stroke patients go through stages of initial flaccidity, increasing tone, and then into more normal movement so I don't agree that once tone sets in, you cannot get rid of it.
However, I will say that the persons I have seen overcome tone usually do so in the first few months after stroke. This is not a proven fact but just my own personal observation with patients.
Patients that I've seen with high tone for an extended period of time often do continue to have problems with tone. From your post, it sounds like your daughter is able to grasp and release objects at times when the tone is not too high. The good thing for you to know is that there are ways to manage or decrease tone allowing for more functional movement in those that do have movement present.
A technique that I teach patients to help control the spasticity is weight bearing. Though weight bearing does not get rid of tone, it often will lessen it so that the patient can move more freely. I would ask your therapist to show you ways to manage your daughter's tone and also teach those techniques to your daughter.
Hopefully that will enable your daughter to relax the hand enough for improved grasp and release. Sometimes it works and sometimes it doesn't. There are also medical means to control spasticity that work for some but not for others.
My experience is with adult clients so I don't know if all the same options are available for children. You can read about various medical management strategies for spasticity at www.
Spasticity that subsides in some patients in my opinion appears to occur as part of the healing process. After the acute healing has occurred and tone is still present, it often continues to linger in my opinion.
Please note that this is only an opinion from my observations with stroke patients. My advice to you is to ask your daughter's physician about the prognosis for tone and to learn spasticity inhibition techniques from the therapist to help your daughter manage the tone as best she can. Question : I was walking pretty good with a quad cane,but now it seems like my leg is getting stiff at knee and up by my groin Also my foot feels like needles ar sticking in the bottom when I take a step.
Answer : Stiffness could be a result of spasticity in the knee and groin. Range of motion activities and stretching for the leg might be helpful if this is the case.
You can have your MD evaluate to see if you have increased spasticity. The level of spasticity often changes during the stroke recovery process so it can take an individual by surprise.
The pins and needles feeling you are experiencing in your feet is most likely paresthesia. Paresthesia is a pins and needles feeling that can be chronic or temporary. It can also come and go after stroke so the outcome is hard to predict. Sometimes stroke victims experience central pain syndrome post stroke.
Central pain syndrome can occur due to damage to the brain and can occur immediately or months after the stroke. Pain may be constant, made worse by touch or pressure, and be sensitive to temperature changes. The pain sensations are often described as pins and needles, burning, or sharp pain. There may also be numbness associated with the pain. These are just a few of the problems that can occur post stroke. I recommend making an appointment with your neurologist to determine the cause of your onset of stiffness and sensory issues as well as to determine if it can be treated.
Question : I had a stroke 06 March After 7 months I start to have spasticity problems. I walk everyday about meters , but stay stiff. Will the stiffness go away and after what period? Answer : Hi Arno. Unfortunately, only time can tell if the spasticity will go away or remain with you.
The longer you have it, the less likely it is to go away on it's own. It is important to stay active and stretch. If the spasticity is interfering with your activity, you might want to talk to your MD about medicine options if you haven't already. You might look into massage therapy as well. It won't get rid of your spasticity but can help with tight, tense muscles which may relieve some of your discomfort.
Question : What is the role of ice in treatment of the flaccid condition of stroke? Please describe in detail. Also, what is the treatment for the spastic stage of stroke? Answer : If the doctor gives the okay, ice can be used to help with swelling in the hemiplegic hand.
You could try this technique for several days and see if swelling decreases. The key points to remember though are that you need physician approval, only leave the hand in for 10 seconds at a time, only perform the technique x throughout the day, and discontinue if there are any problems or no results are seen. One has to be careful when using ice with the hemiplegic hand because the stroke patient often has decreased sensation so close supervision is needed as well as physician approval.
Ice can also be used to facilitate muscles by briefly rubbing ice for a few seconds over the muscle you wish to facilitate e. I prefer tapping as my method of facilitation rather than ice. The best treatment for the flaccid arm and leg is weightbearing, passive range of motion, proper positioning of limbs, and facilitation techniques such as tapping, quick stretch, and electrical stimulation physician approval required for electrical stimulation, and pt.
The spastic limb also requires weight bearing which helps with stretching and reducing tone. Scapular mobilization is important during the spastic stage to help reduce tone and increase shoulder range of motion. For more information on treating the flaccid limb, see the links below: www. For information on treating spasticity, see these links: www. Question: I have a patient with abnormal flexor tone in the left affected UE. She has increased flexor tone in the biceps and fingers and presents with her elbow and wrist in the flexed position.
It is believed she is in stage 2 of brunnstrom. She also has shoulder subluxation greater than 2 fingers and trace muscle contraction of the upper traps. She is currently receiving inpatient rehab services. Her CVA was in the R basal ganglia. What weight bearing activities and interventions would you recommend for her three week stay? Answer : This sounds like a question I would have been asked in therapy school. I'm not going to give you a textbook answer but rather what I would do based on my experience.
Do not leave this type of sling on the patient in a chair because the patient will become stiffer and lose range of motion if kept in this position frequently. I would also try kinesiotaping the shoulder for extra support.
I would initiate e-stim for subluxation if the patient did not have any contraindications for e-stim and the MD was in agreement.
I would also teach the patient and caregiver how to do gentle passive range of motion and educate them on how to protect the arm. I would do range of motion to the arm as well within patient's pain tolerance and using appropriate techniques making sure the shoulder blade is rotating and approximating the humerus to reduce subluxation.
Since the patient only has a short stay in IP rehab, it is imperative to teach them and their caregivers compensatory techniques for ADLs and educate them on equipment that is available. It's also important that the patient knows how to transfer safely or has a caregiver that has been trained to help with the transfer if the patient is unable to do it herself.
One component that is highly missed in IP rehabs is caregiver education. Please educate and also refer the caregiver to websites so the caregiver can prepare for bringing the patient home or start looking at other facilities if home is not an option.
I would also begin to do weight bearing activities with the arm in sitting to decrease tone and see if the patient can hold the arm in place or use it for support. One of the first things I try to teach my stroke patients is being able to place the hand and keep it on an object. I usually start with the patient trying to hold the hand on a mat then progress to see if the patient can keep their hand on a ball e. If the fingers will not lie straight on the mat, you may be able to get the fingers to lie open on the curved ball.
Once you get the fingers open on the ball, you can also apply gentle pressure to the hand to push it back into wrist extension and stretch the forearm flexor muscles.
I will assist the hand to stay on the cane if needed. I also use facilitation techniques and e-stim if appropriate to try and elicit movement. Some of the facilitation techniques I might use would be tapping, stroking or vibration to the muscle belly. I have good results with eliciting elbow extension when tapping the triceps with the patient lying on their back and the shoulder supported at 90 degrees of shoulder flexion which increases extensor tone.
If you can elicit any movement, this will often excite and motivate the patient to try harder. So in review, what I would do in my practice is: 1. Teach patient and caregiver how to transfer and use compensatory techniques for ADLs 3. Use weight bearing activities as described above 4. Try to elicit movement through facilitation techniques.
Answer : I wouldn't say that these devices are necessary after botox treatment, but they can definitely be beneficial. Patients considering these devices should receive a trial run during therapy to determine if the device is right for them. Question : Does botox help in a person's arm or leg? I had it in my arm 3 weeks ago with therapy following, and there is no improvement. My stroke affected my left side.
There is moderate evidence that electrical stimulation combined with botulinum toxin injection is associated with reductions in muscle tone. What is high tone? High tone or hypertonia is increased tension in the muscles which makes it difficult for them to relax and can lead to contractures and loss of independence with everyday tasks. Physiotherapy for high tone At Physio. At Physio. Regular weight bearing activities in the upper and lower limbs.
Practicing functional activities Teaching family or carers on the best position in lying, sitting and standing to help high tone and increase comfort Advice on proper seating to keep the body in a balanced, symmetrical and stable posture to maximise comfort and function Advise on splints and casts to increase range of movement and prevent the formation of contractures Physiotherapy treatment at Physio.
Our motivated physiotherapists at Physio. Our physiotherapists also work closely with occupational therapists, who can help design changes in the home and provide equipment to accommodate your needs. Physiotherapy at Physio. Above: Deep tissue massage used to lower tone in muscle applied by an experienced therapist. Email: office physio.
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