Treatment:

Conservative Treatment:

• Slow, prolonged stretching of the arm is used to reduce spasticity.

• Weight bearing reduces spasticity of the tight muscles of the arm while also promoting a muscle contraction of the weak muscles of the arm.

• Supporting, positioning, and aligning the body is useful to minimize or prevent pain and stiffness that are commonly present due to spasticity.

• Warming the arm for 10-20 minutes is a sufficient period to produce a temporary effect of reducing spasticity. The application may be by wrapping body part with towels, hot packs, tepid baths and air splints.

• Icing immersion of the hand produces a temporary effect in reducing spasticity (proceed with caution)

• Deep tendon pressure

• Orthotics (splints) to lengthen shortened muscles and tendons that result from spasticity.

Oral Medication:

• Baclofen: Baclofen is a muscle relaxer that acts on the central nervous system to relax muscles. Baclofen decreases stretch reflexes, the rate of muscle spasms and clonus, pain, tightness, and improves range of motion. Side effects can include sedation, dizziness, muscle weakness, urinary frequency, drowsiness, confusion, nausea, seizures, constipation, dyspnea, impaired vision, fatigue, and edema.

• Tizanidine (Zanaflex): Tizanidine is a short-acting muscle relaxer. It works by blocking nerve impulses (pain sensations) that are sent to your brain. Tizanidine is used to treat spasticity by temporarily relaxing muscle tone. Side effects drowsiness, dizziness, weakness, feeling nervous, blurred vision, dry mouth, abnormal liver function tests, runny nose, urination problems, vomiting. 

• Gabapentin (Neurontin): Used to treat pain due to spasticity. Side effects include drowsiness, loss of coordination, dizziness.

• Pregabalin Lyrica: Similar to gabapentin, pregabalin was developed as a treatment for epileptic seizures, but it has evolved to include other indications, such as neuropathic pain.

• Diazepam has been shown to cause muscle relaxation, which has led to their use in reducing the increased tone associated with spasticity.

• Cannabis: There has been anecdotal evidence that cannabis can reduce spasticity in persons with spinal cord injury, as well as a growing body of work that has examined this class of drug in managing spasticity in persons with multiple sclerosis.

Baclofen Pump:

• Intrathecal Baclofen Therapy is a pump that is surgically implanted and releases Baclofen into the spinal cord. Patients who benefit from the effects of oral Baclofen but cannot tolerate the side effects may benefit from intrathecal Baclofen.

• Side effects are usually minimal because the drug is delivered directly to the intended site rather than circulating through the body. Complications can occur related to the pump and may include infection, catheter dislocation or kinking, impaired wound healing, and pump malfunction. Possible side effects can include headaches, nausea, vomiting, excessive weakness, and transient urinary retention. 

Botox Injection:

• Botulinum toxin (Botox, Myobloc, & Dysport) is injected into the muscle and temporarily stops the connection between nerves and muscles, causing spasms to stop. The effects usually occur within 24 to 72 hours with maximum effect seen in about 2 weeks. The effects last from about 12 to 16 weeks.

• Adverse reactions can include nausea, fatigue, muscle weakness and limb pain.

• Myobloc is used to treat severe spasms in the neck muscles.

• Dysport and Botox are essentially the same drug, but Dysport produces quicker results. Both last for the same amount of time.

• A Phenol injection can also provide relief from spasticity. Phenol destroys the nerve pathways to the involved muscle group, blocking nerve impulses to the muscle. The relief can last from several weeks to 6 months or more. Side effects can include pain and burning/tingling and swelling of the injected area.
  

Surgery:

• Tendon transfers/lengthening

• Surgical tendon lengthening is considered when the wrist or fingers cannot be passively extended or opened fully.

Test your own level of spasticity:

This is an adapted version of the Modified Ashworth Scale, a common test used by medical professionals to test the amount of resistance a spastic muscle produces when it is stretched.

Step 1: In a seated position, place your affected arm on a table in front of you.

Step 2: Passively bend your affected elbow with your unaffected arm.
Step 3: Quickly straighten your affected elbow with your unaffected arm within 1 second.
Step 4: Repeat bending and straightening your affected elbow 2 more times, 1 second each.

Scoring:

0 = No increase in tone (you do not feel resistance when you try to straighten your affected elbow).

1 = Slight increase in tone (you feel a little resistance when you straighten your affected elbow, but only at the end of the stretch).

1+ = Slight increase in tone (when you passively straighten your elbow, you feel a "catch" about halfway, followed by a little resistance throughout the remainder of the stretch.

2 = You feel resistance throughout the entire movement (from being fully bent to being fully straightened).

3 = You feel a lot of resistance, It is very difficult to stretch your elbow from a bent to a straightened position due to the amount of resistance.

4 = You can't passively bend or straighten your elbow at all, it is rigid in a bent position.

Reference: OTNotes.com https://otnotes.com/wp-content/uploads/2017/05/Modified-Ashworth-Scale.pdf

Page last updated: 1/19/2021