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Spasticity
http://photo-dictionary.com/phrase/5533/clasp-knife.html#b
http://virtualworlds.wikia.com/wiki/3d_models_list_old
• Spasticity
• Velocity dependent resistance
• Feel at beginning of range of motion
then releases
• Clasp-knife Spasticity
• Rigidity
• Increased resistance throughout range
of motion
• Lead Pipe Rigidity
• Cogwheel
• Intermittent, regular resistance
throughout the range of motion
http://www.mhl.soton.ac.uk/public/Main/research/projects/dormant/cogwheel/index.html
Reflexes
• Grade 0= Absent
• Grade 1= Hypoactive
• Can elicit with distraction
(pull hands apart)
• Grade 2= Normal
• Grade 3= Hyperactive
• Spreading of reflex
• Grade 4= Clonus
http://www.adinstruments.com/solutions/experiments/labchart_experiments/full.php?exp_id=239&section_id=24&group_id=5&name_id=308&template=education
Upper Motor Neuron Injury
• Result of injury to CNS
• Brain, Spinal Cord
• Stroke, Cerebral Palsy, Spina
Bifida, Multiple Sclerosis, Spinal
Cord Injury
• Loss of inhibition of local reflexes
from descending spinal tracts
(pyramidal tract)
• Spastic Paralysis
• Hyperreflexia, Spasticity, Positive
Babinski, Disuse Atrophy
• Dominance of Rubrospinal tract
• Flexion of upper extremities
• Extension of lower extremities
http://monensberkshire.blogspot.com/2010/06/pyramidal-tract.html
Lower Motor Neuron Injury
• Injury to alpha motor neuron
• Anterior Horn (Polio Myelitis,
SMA)
• Peripheral Nerve (Trauma,
GBS)
• Flaccid Paralysis
• Hypotonia, Absent Reflexes,
Fasciculations, Severe Atrophy
http://medical-dictionary.thefreedictionary.com/lower+motoneuron
Secondary Effects
http://www.nlm.nih.gov/medlineplus/ency/presentations/100056_1.htm
http://medical-
• Contractures
• Ankles (Clubfoot deformity),
Knees, Hips, Elbows, Wrists
• Worsen with growth
• Hip Dislocation
• Surgical correction
• Scoliosis
• Seating problems,
cardiopulmonary compromise
• Bracing, Surgery
Spasticity
• Results in pain, decreased mobility,
contractures, spasms, interferes with sleep
and ADLs
• Therapy
• Repeated, gradual, sustained stretching
• Serial casting
• Orthoses
• Orthopedic surgery
• Muscle and tendon lengthening
• Lengthened muscles loses grade of
strength
• Repeat interventions as grow
• Medications
• Generalized spasticity
• Prevent mass extensor spasm
• Less used in high function due to side effects
Oral
• Limited efficacy
• Side effects are dose limiting
• Slow dose elevation
1.Baclofen
2.Tinazidine
• Centrally acting alpha-2 agonist
3.Diazepam or Clonazepam
• Benzo, GABA-A agonist
• Can use with Baclofen or Tinazidine
• Useful for nighttime spasm
4.Dantrolene
• Peripherally acting
• Inhibits Ca2+ release from SER
• Produces more weakness than any other med
• Hepatotoxicity: monitor LFTs
5.Other
• Clonidine, Gabapentin, Cannabinoids, Cyproheptadine
• Intrathecal
• Baclofen
• Centrally acting
• Poor at crossing BBB
• Decreased systemic side effects
• Increased complications
• Spinal fluid leaks
• Hemorrhage
• Infection
• Catheter Dislodgement
• Pump Failure
• Injections
• Chemodennervation:
• Avoids systemic side effects
• Muscle weakness and injection site reactions
• 1. Botulinum-A Toxin
• 2. Phenol
• 3. Alcohol
Dystonia
• Dystonia Defined:
• Sustained painful muscle contraction
• Results from defect at level of basal
ganglia (extrapyramidal)
• Common causes:
• Inherited/ Metabolic Disorders
• CO Poisoning
• Encephalitis
• Focal Brain Disease
• Medication Induced
• D2 Blockers
• Antipsychotics, Metoclopramide
http://www.ninds.nih.gov/news_and_events/news_articles/cerebellum_in_dystonia.htm
Treatment
• Anitcholinergics are most effective
• Baclofen, carbamazepine, clonazepam
• Focal dystonias- Botulinum toxin
References
• O’Young, B., Young, M., Stiens, S.
(2008). Physical Medicine and
Rehabilitation Secrets. Philadelphia, PA:
Mosby Publisher.
• Lexicomp. Baclofen: Drug information. In:
UpToDate, UpToDate, Waltham, MA,
2012.
• Lexicomp. Botulinum toxin type A
(onabotulinumtoxinA, Botox®): Drug
information. In: UpToDate,
UpToDate, Waltham, MA, 2012.