Why is there one-sided clubbing in hemiplegia

Spasticity - what is it?

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Spasticity (also known as spasm or spasticity) is derived from the Greek word spasmós and means cramp. From a medical point of view, it is a pathological increase in muscle tension (also known as muscle tone), which is caused by damage to the central nervous system (CNS). The overactive muscles lead to permanent hardening and stiffening, so-called spastic paralysis. These are associated with restrictions on mobility.

Basics

Spasticity (also known as spasm or spasticity) is derived from the Greek word spasmós from and means cramp. From a medical point of view, it is a pathological increase in muscle tension (also muscletone caused by damage to the central nervous system (CNS).

The overactive muscles lead to permanent hardening and stiffening, so-called spastic paralysis. These are associated with restrictions on mobility.

It is not uncommon for the stiff muscles to lead to painful and disfiguring postures. For those affected, this sometimes means lasting impairments in their everyday activities and in their quality of life.

Spasticity is not a disease but a symptom (sign of illness) of damage to the central nervous system (brain and spinal cord), for example after a stroke or traumatic brain injury. For those affected, it can be associated with severe impairments in their everyday life and a high level of suffering.

Spasticity is not always spasticity

Spastic paralysis (also referred to as spasticity or spasticity) can occur in different degrees of severity and extent and with different side effects. This has to do with which areas of the brain are affected and how badly.

Spastic paralysis can manifest itself as a slight muscle stiffness with only minor restrictions on movement or as permanent muscle cramps with severe restrictions or even complete inability to move.

Since spasticity is associated with a limitation of mobility, it is also referred to as spastic paralysis or spastic paresis.

The severity of the spasticity depends on how strong the areas of the brain or spinal cord are damaged.

Classification of spasticity according to extent

Spastic paralysis can affect individual muscles or entire areas of the body. The extent of the paralysis is related to Which Areas of the brain or spinal cord are damaged.

If the spasticity is locally limited, one also speaks of one focal spasticity.If all limbs are affected, the spasticity is called generalized designated.

A more precise distinction to the extent of the spasticity is made as follows:

  • Monospasticity: A leg or arm is affected by the spasticity.
  • Paraspasticity: Both arms or legs are affected by the spasticity.
  • Hemispasticity: One arm and one leg on one side of the body are affected by the spasticity.
  • Tetraspastic: Both legs and arms are affected by the spasticity. Depending on the severity, the neck and trunk muscles can also be affected.

More symptoms

Spasticity can be accompanied by other symptoms (signs of illness), which are also caused by damage to the brain or spinal cord. These include, for example:

  • Impaired movement control / coordination
  • Uncontrolled muscle movements
  • Flaccid paralysis
  • Exhaustibility, weakness
  • Pain and / or sensitivity disorders

Particularly in the case of spasticity after a stroke, in addition to the spastic paralysis, one-sided flaccid paralysis often occurs, which affects the arm and leg of one half of the body.

The symptoms of spasticity are related to Where and how strong the central nervous system (brain and spinal cord) is damaged. Accordingly, the associated functional impairments can range from only slight restrictions in freedom of movement to complete physical disability.

How does spasticity occur?

The cause of spasticity is damage to the central nervous system (CNS), i.e. the brain, spinal cord or their connections.

There are areas that communicate with the Skeletal muscles connected and in this way control our movements. In spasticity, it is precisely these areas of the CNS that are affected.

  1. brain
  2. signal
  3. Spinal cord
  4. Stimulus transmission
  5. Skeletal muscles
  6. nerve

Our movements are based on a harmonious interplay of muscles. The commands for this come from the CNS and are transmitted to the skeletal muscles via nerve tracts.

Normally, the nerves give the muscle the signal to become active by increasing its tension (the muscle turns into a so-called State of excitement offset). If the tension is high enough, the muscle tenses briefly and shortens: it comes to Muscle contractionbefore the muscle returns to its relaxed initial state.

In spasticity there is damage to the CNS, which leads to a disturbed fine-tuning between muscle tension and muscle relaxation. The muscle is permanently put into a state of excitement by the nerves. This can result from a slight increase in the internal tension of the muscle (increased muscletone) to a clear command for muscle contraction (muscle tension).

In any case, under these circumstances, the activity of the muscle - and thus the movement it emanates - can no longer be controlled. Spastic paresis or paralysis occurs.

Example of unrestricted muscle contraction

Example of spasticity in the wrist

Example of unrestricted muscle contraction

  1. Voluntary muscle contraction or relaxation
  2. Move

Example of spasticity in the wrist

  1. Uncontrolled or persistent muscle contraction
  2. Restricted freedom of movement

Our movements are based on a harmonious interplay of muscles that is controlled by the central nervous system (CNS). In spasticity, damage to the CNS (brain and spinal cord) leads to dysregulation of the skeletal muscles. The muscles are put into a state of permanent excitement and tension by the nerves.

The damage to the brain or spinal cord can have many causes, including: B .:

  • stroke
  • Accidents with traumatic brain injuries or spinal cord injuries
  • multiple sclerosis
  • Early childhood brain damage
  • Inflammation of the brain (meningitis, myelitis, encephalitis)
  • Brain tumor

Spasticity can therefore occur in adults as well as in children and adolescents. An estimated 250,000 people are affected in Germany, including around 50,000 children (Reichel, 2004).

The spasticity can occur soon or with a delay of weeks or months after the actual damage to the central nervous system.

The most common cause of spasticity is a stroke or cerebral infarction.
In Germany, 250,000 people suffer a stroke every year (Stiftung dt. Stroke Help). In more than a quarter, spasticity develops after a period of approx. 3-6 months (also known as spastic paralysis or spasticity).

How do I recognize spasticity?

Spastic paralysis can occur in individual muscles or entire muscle groups.

Because the muscles attach to the joints, muscular shortening and tension are mainly expressed in these connecting elements. As a result of spasticity, there is limited mobility and sometimes bizarre incorrect posture of the joints.

Arm spasticity manifests itself in the shoulder, elbow, wrist and finger joints. Leg spasms can be seen in the joints of the hips, knees, ankles and toes.

Common clinical manifestations of spasticity in the arm and hand:

Forearm turned inward

Common clinical manifestations of spasticity in the leg:

How is spasticity diagnosed by the doctor?

To diagnose spasticity, the doctor first examines the patient physically. In addition, he will likely do some neurological tests and use imaging tests (e.g. CT, MRI).

In particular, the muscle stiffness, i.e. the severity of the spasticity, and the difficulties that result for the person concerned in everyday activities are assessed.

The following is determined:

  • the degree of restriction
  • the muscular strength
  • the muscle tone (measurement of the degree of tension in the muscles, e.g. using the Ashworth scale)
  • the mobility of the joints (by assessing the range of motion)
  • the pain intensity

The information helps the doctor diagnose and plan the subsequent therapeutic measures to resolve the spasticity. Furthermore, the response to the treatment can be assessed and tracked using rating scales.

The Ashworth scale (after Ashworth 1964) or the modified Ashworth scale (after Bohannon and Smith 1987) is a common method for assessing the spasticity of muscles. It measures the increase in muscle tension (muscle tone) during passive movement.