spasticity management

what is spasticity?

Spasticity can be described as involuntary muscle stiffness. It can range from mild to severe and change over time, often from day to day or hour to hour. Symptoms can be unpleasant but sometimes spasticity can be helpful; if a person’s legs are very weak the stiffness spasticity causes may actually help in transferring from bed to chair or even in walking. The key to successful spasticity management is a holistic team approach.

why does spasticity occur?

Nerve pathways connecting the brain, spinal cord and muscles work together to coordinate movements of the body. These pathways can be disrupted in neurological conditions such as stroke, multiple sclerosis, brain or spinal cord injury, leading to loss of this co-ordination and over activity of muscles causing muscle spasms and tightness that is described as 'spasticity'.

how do I know if I have spasticity?

The main feature of spasticity is stiffness or increased resistance when attempting to move a limb or joint. Other features that may be associated with it include spasms, pain, weakness and clonus.

stiffness or increased resistance to movement – some people with spasticity describe their muscles as feeling stiff, heavy or difficult to move. When very severe it can be very difficult to bend a limb at all. Muscle stiffness can also occur in an individual’s trunk/body. Sometimes individuals can have mixed symptoms, for example their trunk/body may be weak/floppy but their legs may be stiff and difficult to move. These mixed symptoms need careful management
Flexor Spasms can be described as sudden involuntary contractions of muscles that can make your arms, legs or body move in different ways.
pain – spasticity can be painful, but not always. If pain is present it may be linked to spasms, stiff muscles or is a consequence of altered sitting and lying positions.
weakness – despite a limb resisting movement (an increase in tone) the muscles may also be weak; this may increase the feeling of heaviness in arms or legs.
clonus – a repetitive, up and down movement, often of the feet; it may be observed as a constant tapping of a foot on wheelchair foot-plates.
other symptoms associated with spasticity can include fatigue and loss of dexterity

what problems can spasticity cause?

Spasticity and its associated features can affect all aspects of daily life. For example, it can affect the way you walk, transfer, sit in a chair, turn over in bed, carry out your care needs, sexual activities and it can affect your overall comfort and mood. Furthermore, persistent spasticity can lead to poor postures in lying and sitting which can lead to pain, pressure sores or contractures (when a limb becomes fixed in one position). However there are many steps you can take to minimise the impact of spasticity on your daily life.

how do I get referred?

As we will need some information about your condition, your medication and any previous spasticity treatment, we will need you to ask your physiotherapist to refer you to STEPS. We take self referrals.

what can I expect from my first assessment?

You will be seen by a consultant in stroke or rehabilitation medicine and specialist physiotherapist who will work closely with you to work out how your spasticity impacts you, if there are any triggers that could be causing your spasticity, and discuss a management plan with you.

There are a number of treatment options available and your package of care will be tailored to your individual needs and aims.

Treatment options that may be discussed are,

Botulinum Toxin injections
suggestions of medications to help with muscle tightness, pain from your nerves or to manage potential spasticity triggers

Referrals to other therapies that may compliment your treatment and help you to manage your spasticity will be discussed as part of your treatment plan. These complimentary interventions may include,

exercise and stretching
seating advice and assessment
orthotics
functional electrical stimulation
bladder and bowel management
fatigue management
stress and anxiety management
positioning and posture support and advise
monitoring of impact of changes to your medications
family/carer education for help with stretches, exercises, positioning

how much will it cost?

As a minimum, you will require an initial assessment session. The first session will be a minimum of an hour.

If it is decided to be the best treatment option for your spasticity, you may be injected with Botulinum Toxin, which may be offered within your initial assessment. The cost of this toxin will vary depending on the dosage you require.

Once your individual treatment plan has been agreed with you we will provide details of the costs involved. If you have received injections of Botulinum Toxin there will be a follow up required with the Consultant and at least one session to provide advice and education for your family/carer to provide support with stretches, exercises and positioning.