Severe long term spasticity may lead to contractures of the muscles, a chronic and incurable shortening and tightening. With contracture also comes the possibility of fixed and immobile joints, often at an unusual angle.
Hypertonicity (increased muscle tone):
Hypertonicity is an increased tension of the muscles, meaning the muscle tone is abnormally rigid, hampering proper movement. Neonatal or congenital hypertonia is usually a result of severe brain damage. Infants experiencing hypertonicity often have joint contractures and general discomfort as well as difficulty feeding. Neonatal hypertonicity is managed with neurodevelopmental techniques in the positioning and handling of the infant.
Clonus is a series of involuntary muscular contractions due to sudden stretching of the muscle. Clonus is a sign of certain neurological conditions, and is particularly associated with upper motor neuron lesions such as in stroke, multiple sclerosis, spinal cord damage and hepatic encephalopathy. Unlike the small, spontaneous twitching known as fasciculations (usually caused by lower motor neuron pathology), clonus causes large motions that are usually initiated by a reflex.
Clonus is most common in the ankles, where it is tested by rapidly flexing the foot upward (dorsiflexion). It can also be tested in the knees by rapidly pushing the patella towards the toes. Only sustained clonus (5 beats or more) is considered abnormal.
According to researchers, a change in a person's spasticity can be a symptom itself. For example, a cyst or cavity in the spinal cord (sometimes called post-traumatic syringomyelia) could lead to more spasticity. Also, decreasing or disappearing spasticity can also be a sign of a cyst.
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 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 spasticity.
Cerebral palsy is an umbrella term used to classify conditions that impair motor coordination caused by brain damage. Cerebral palsy is caused by brain damage occurring before, during, or after birth. Any brain damage inflicted up until approximately the age of three can result in cerebral palsy. The part of the brain that is damaged is the determining factor on how the condition affects the patient. Spastic cerebral palsy occurs when the brain damage occurs in the cerebral cortex, the outer layer of the brain. Spastic cerebral palsy is the most common form of cerebral palsy, affecting 70 to 80 percent of patients. Spastic cerebral palsy has varying forms depending on the areas of the body it affects. Normal muscles work in pairs: when one group contracts the other group relaxes, allowing free movement in the desired direction. Due to complications in brain-to-nerve-to-muscle communication, the normal ebb and flow of muscle tension is disrupted. Muscles affected by spastic cerebral palsy become active together and block effective movement. This causes the muscles in spastic cerebral palsy patients to be constantly tense, or spastic.
Spastic cerebral palsy patients may have mild cases that affect only a few movements, or severe cases that can affect the whole body. Although spastic cerebral palsy is not thought to be a progressive disorder, as brain damage does not get worse over time, spasticity in muscles can increase over time. This increased muscle tone and stiffness can limit the range of movement in the joints. The effect may increase with anxiety or exerted effort, leading to excessive fatigue.
Three out of every four people with MS have spasticity. Spasms and spasticity cause the muscles to tighten, but then they do not relax. People can react in different ways to spasticity. For example, a leg can suddenly become stiff or refuse to bend, while at other times a leg will be completely limp. Spasticity may cause one person's arm to simply feel stiff and another person to have an elbow that is impossible to bend. Spasticity and spasms can also make it difficult to sleep at night. For many people with spasticity, the extra work it takes to move around when the muscles are stiff can make them tired or fatigued. The increased stiffness in the muscles means that a lot of energy must be used for daily activities.
Reducing spasticity gives a person with MS greater freedom of movement and can increase strength and coordination. Occasionally however, spasms in the legs may give you a sense of security when you stand not because you have gained more strength but because the spasms are making your legs feel stiff when you stand. In this case spasms can actually be helpful. If you are being treated for spasms and are no longer able to stand, transfer, or walk, you should discuss this with your medical team. If spasms and spasticity don't cause you pain or interfere with daily activites, you and your doctor may decide that it isn't necessary to treat them.
Spastic diplegia is a form of cerebral palsy where both the arms and legs have abnormal stiffness. The legs are often more affected than the upper extremities. Spastic means stiff or contracted. The word Diplegia breaks down into "di," meaning two, and "plegia," the Latin word for weakness. Therefore, spastic diplegia means stiff or contracted muscles affecting two extremities causing weakness. Spastic Diplegia is sometimes also called paraplegia. There are other forms of Spastic Diplegia besides cerebral palsy. Some forms of spastic diplegia are hereditary.
Diplegia, like other forms of CP, is hard to detect early on. Warning sings may include stiff lower extremities or floppiness of the limbs that turn stiff later. There are no tests or scans that can detect CP, and it has to be diagnosed based on motor movement. Before the age of 1, if your child appears to have leg problems or tightness, gentle stretching and exercise is healthy, though never too much to discomfort the child. Your infant may also benefit from an infant stimulation program. Between ages one to three, diplegia is usually noticed and can be diagnosed because the child is not walking. If by age 2/12 your child is not pulling to a stand, he may have severe involvement and a standing program should be initiated. Standing programs are only recommended for children with severe involvement.
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