Disease Awareness - Spastic Movement Disorder
What is spastic movement disorder ("spasticity")?
Spasticity is a movement disorder resulting from disinhibited spinal reflexes resulting from damage to the upper motor neuron and dysregulation of the efferent inhibitory pathways, and is associated with an increase in the velocity-dependent stretch reflex, which is also reflected in an increase of muscle tone.*
* Trompetto C, Marinelli L, Mori L, et al. Pathophysiology of Spasticity: Implications for Neurorehabilitation. BioMed Res Int. 2014;2014:354906. http://downloads.hindawi.com/journals/bmri/2014/354906.pdf, last accessed on April 1, 2022.
Characteristic features of spasticity
- Speed dependence
- "Pocket knife" phenomenon
- "Stroking" effect
- Typical distribution
Stroke is the most common etiology of adult spasticity
Approx. 270,000 strokes per year.
Heuschmann PU, Busse O, Wagner M et al., Stroke frequency and care of stroke patients in Germany. Akt Neurol 2010; 37(07): 333-340.
Approximately 20 to 40% of all stroke patients develop a spastic movement disorder within a year
Potempa C et al., On the care situation of patients with spastic movement disorders in Germany. Health Services Research Monitor 03/2019. 12th year 04.06.2019.
Stroke is a major cause of disability in adulthood
Murray CJL, Vos T, Lozano R et al., Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380(9859): 2197–2223
About 6% of stroke patients are permanently dependent on inpatient care
Potempa C et al., On the care situation of patients with spastic movement disorders in Germany. Health Services Research Monitor 03/2019. 12th year 04.06.2019.
Factors of impairment and disability in spasticity
Three main factors are responsible for functional limitation and disability in spastic paralysis:
1. Paresed.
that is, decreased voluntary responsiveness of skeletal motor units.
2. Contracture of soft tissues, especially muscle shortening with joint misalignment
3. Hyperactivity of muscles
that is, decreased ability of muscles to relax
What are the most common symptoms of spasticity?
- Increased muscle tone
- Hyperactive reflexes
- Problems with personal hygiene and grooming
- Abnormal posture
- Contractures
- Bone and joint deformities
- Pain
- Involuntary movements
- Decreased functional abilities
- Delayed motor developmen
Spasticity of the upper extremities
Typical patterns
Upper arm
- Problems using/moving arms
- Arms remain in uncomfortable position
- Moving or stretching the arm is difficult/ painful
Elbow
- Pronation of the forearm
- Elbows bent
- Movement or stretching of the elbow only possible with difficulty/under pain
- Flexion of the elbow
This is what spasticity in the arm can look like
Wrists
- Flexed wrists
- Movement or stretching of the wrists only possible with difficulty / pain
- Flexion of the wrist
Hands and fingers
- Hands clenched into fists
- Movement or stretching of the fingers only possible with difficulty / pain
- Flexion of the fingers and adduction of the thumb
The vicious circle of spasticity
Therapy goals
Rehabilitation ➤ As early as possible
BoNT physio: stretching/strengthening
Symptoms ↘︎
Motor function ︎↖︎
Independence ︎ ↖︎
Note: For reasons of better legibility, the masculine form is used for personal designations. Corresponding terms generally apply to all genders in terms of equal treatment. The shortened form of language is for editorial reasons only and does not include any rating.