Spasticity

Spasticity develops as a result of damage to the spinal cord or to the brain. The term comes from the Greek word “spasmos”, which means muscle cramp. Spasticity and spasms frequently play a central role in the lives of people with spinal cord injuries and their caretakers.

Why does spasticity occur?

The regulation of body tension is very complex. Movements are controlled jointly by the brain and the spinal cord. The spinal cord injury causes an interruption of the ascending and descending nerve paths in the spinal cord via which regulation is controlled. The brain loses its influences over reflexes and over the development of strength in the musculature.

Reflexes are involuntary movements which are controlled directly via the reflex arc in the spinal cord. The regulation of the reflexes is disrupted by the interruption to the spinal cord; they are no longer “braked”, and they respond strongly. Therefore, many people with spinal cord injuries suffer from increased muscle tone¹ or cramp-like muscle activity.

Difference between spasticity and spasms

Spasticity means that the basic tone of the muscles in the paralysed parts of the body is increased. Spasms are unspecific responses to stimuli. As the central control via the spinal cord is lost, non-specific muscle contractions occur in response to sensory stimuli. A distinction is made here between flexor and extensor spasms, depending on whether the flexor or extensor muscles are more affected.

What this means to people affected

Spasticity means that the body works at the highest level of effort and results in very high energy consumption. The possible movements in the joints are restricted because the surrounding muscles are tensioned in such a way that any elasticity and, thus, the scope for movement are lost. As a result, movements take great effort which, among other things, can restrict independence. However, there are lots of positive effects to spasticity. It gives the body greater stability, causing those parts of the body which are affected by paralysis to follow the pulses of those which are not because the joints do not permit movement in any other direction due to the high tension of the surrounding muscles.

Shooting spasms may be used in a beneficial manner for performing some daily routines, e.g. during transfers where extensor spasms may enable the person to stand for a short time, to raise his or her legs up onto the bed or when getting dressing, where reflexor spasms may be useful.

If the spasms occur very surprisingly, they may also pose a risk because they may disrupt movements, leading to falls and injuries.

What this means to care personnel

Dealing with people with spasticity poses great challenges to care personnel. Care often takes great effort, for the muscle contraction of the patient can easily be transferred to the caretaker.

Key points in care

In spasticity

• People regulate their tension through movement. Therefore, frequent small changes in position are preferable to long intervals in any one position.
• When positioning the person, it is important to ensure that he or she is in a low state of tension. Fixing the legs in place in the bed generally increases body tension.
• You can put the person in a variety of possible positions in order to lower body tension. The frog and extended positions have proved to be the most effective.

In spasms

• Spasms are frequently triggered by touching. Some points of contact are more sensitive to the touch than others; they are what are known as trigger points. Trigger points include the hollows of the knees, the soles of the feet and the abdominal wall; they should be omitted during touching or should not be touched during initial contact.
• Spasms often occur very surprisingly, which can be dangerous for the people affected as well as for their caretakers. Therefore, care has to be taken with people who often experience shooting spasms. Sudden extensor spasms during transfers or reflexor spasms of the legs in bed may pose a risk to safety, whereas extensor spasms generally do not occur at a bend in excess of 90°.

¹ Muscle tension