Episode 8: Spasticity

Featured expert Bridget Ripa, PT, DPT, NCS, CBIS, CSRS

Notes by Alexis Lancaster, SPT

What is it

 

  • A type of tone
  • Two types of tone exist: hypotonic and hypertonic
  • Spasticity is a velocity-dependent resistance to stretch: this is the biggest difference between “tone” in general and “spasticity”
  • Can lead to synergistic movement patterns

 

Anatomy

 

  • You won’t see spasticity unless there has been an injury to the CNS or the motor neuron
  • Typical presentation of synergies when you see spasticity:
  • Flexor synergies in the upper extremities
  • Proximal extensors of the lower extremities
  • Distal flexors of the lower extremities

 

Differential Diagnosis

 

  • Differentiate “tone” from “spasticity”
  • What may present like spasticity:
  • Decreased muscle flexibility
  • Multi-trauma/anxious patients & muscle guarding
  • Red flag to know it is spasticity: velocity dependent!

 

Special tests

 

  • Modified Ashworth (gold standard for measuring spasticity): grades spasticity, scale= 0-4

 

Treatment examples:

 

  • Early intervention is very important
  • As soon as you notice spasticity, focus should shift to positioning, splinting if necessary, bracing, PROM, serial casting could be an option for more serious cases
  • Medications: Botox, baclofen pump
  • Surgery can be an option if ROM is significantly impaired

 

How can it look on the test?

 

  • Questions will be about identifying spasticity or the best way to treat it
  • Example: Patient incurred a right CVA, he is a month out and demonstrating moderate spasticity in the left upper extremity, showing increased flexor tone. The major problem at this point is the lack of voluntary movement control. There is active movement but it is minimal and the patient has a ¼ inch separation of the shoulder. The initial treatment activity of greatest benefit would be with the patient sitting, weight-bearing on the extended affected upper extremity.
  • Need to think about what the best option would be, go with the evidence and gold standard