Spasticity and

What is ? Spasticity is the uncontrolled tightening or contracting of the muscles that is common in individuals with spinal cord . About 65%–78% of the SCI population have some amount of spasticity, and it is more common in cervical (neck) than thoracic (chest) and (lower back) injuries . Symptoms and severity of spasticity vary from person to person and can include: Northwest Regional System . Sudden, involuntary fl exing (bending) or extending (straightening) of a limb,

Department of Rehabilitation or jerking of muscle groups such as in the trunk (chest, back, and ), Medicine bladder, or .

University of Washington . Hyperactive (overactive) refl exes, such as a muscle when you are Box 356490 lightly touched. Seattle, WA 98195 . Stiff or tight muscles at rest, so that it is diffi cult to relax or stretch your 206-616-2183 muscles. [email protected] http://sci.washington.edu/ . Muscle tightness during activity, making it diffi cult for you to control your movement. What causes spasticity? Print this document: http://sci.washington.edu/ The of the spinal cord and form a complex communication circuit info/pamphlets/ that controls our body movements. Information on sensations or processes spasticity_msktc.pdf such as touch, movement or muscle stretch is sent up the spinal cord to the brain. In response, the brain interprets the signal and sends the necessary commands back down the spinal cord to tell your body how to react. The reaction of the body, such as jerking away from a hot object, is a refl ex and happens quickly and automatically. After a spinal cord injury, the normal fl ow of signals is disrupted, and the mes- sage does not reach the brain. Instead, the signals are sent back to the motor cells in the spinal cord and cause a refl ex muscle spasm. This can result in a This publication was twitch, jerk or stiffening of the muscle. produced by the SCI Model Systems in collaboration Just about any touch, movement or irritation can trigger and sustain . with the Model Systems Knowledge Translation Common triggers are: Center (http://msktc. washington.edu) with . Stretching your muscles. funding from the National . Moving your or leg. Institute on Disability and Rehabilitation Research . Any irritation to the skin, such as rubbing, chafi ng, a rash, in-grown toenails, in the U.S. Department or anything that would normally be very hot or cold or cause . of Education, grant no. H133A060070. . Pressure sores. . A urinary tract or full bladder. Spinal Cord Injury Model Systems Consumer Information

Copyright © 2011 Model Systems Knowledge Translation Center (MSKTC). . Constipation or large hemorrhoids. Physical treatments . Fracture or other injury to the muscles, The following treatments will help to maintain fl ex- or bone below the level of spinal cord injury. ibility and therefore reduce spasticity and the risk for permanent : . Tight clothing, wraps or binders. Spasticity can be irritating, inconvenient or even . Regular stretching (range-of-motion) exercises limit your ability to go through your day. twice daily will help maintain fl exibility and tem- porarily reduce muscle tightness. What are the benefits of spasticity . Weight-bearing or standing with support, such in SCI? as using a or other supportive Spasticity is not always harmful or bothersome and devices, will help stretch muscles. does not always need to be treated. Sometimes . Splints, braces, or progressive casting into the spasticity can help with functional activities such as desired position provides continuous muscle standing or transferring. Spasticity that causes your stretching that helps to maintain fl exibility and a fi ngers to bend can help you grip objects. Spastic- position that does not trigger a spasm. ity can also be a signal that you have a medical . Careful use of hot or cold packs. When used in problem that you might not know about other- body areas that have partial sensation, check skin wise, such as a , fracture, or tolerance frequently as it may result in a if too pressure sore. hot and frostbite if too cold. Avoid the use of hot What problems are caused by packs over areas without sensation. spasticity? Medications . Spasticity can be painful. When physical measures are not enough to control . Spasticity can result in loss of range of motion in spasticity, medications may be needed. your (). . Oral medications . Severe spasms can make it diffi cult for you If spasticity involves large areas of your body, your to drive or transfer safely, or to stay properly doctor may prescribe one or more of the following seated in your wheelchair. medications: . Spasticity in your chest muscles may make it dif- • fi cult to take a deep breath. • Benzodiazepines (muscle relaxants) such as , . Strong spasms in the trunk or legs can cause you • to fall out of your wheelchair when you change • position, transfer, or ride over uneven surfaces. The effectiveness of these medications varies with . Repeated muscle spasms at night can cause you each person. Because these medications can have to sleep poorly and be tired during the day. side effects such as fatigue or drowsiness, , . Spasms can cause rubbing that leads to skin , or sometimes low , your breakdown. provider needs to monitor you closely. . Spasticity can make movement harder to con- . or motor point blocks trol, so that activities such as feeding yourself If only part of your body has spasticity, anesthetic may be more diffi cult. medications, alcohol, phenol or (such as strains of ) can be injected into Managing spasticity after SCI the muscles that have spasticity. The medications Spinal Cord Injury Model Systems Consumer Information First, practice healthy behaviors and good self-care rarely cause widespread side-effects. The benefi ts of that will help you avoid problems that can increase the injections are only temporary, however, so in- spasticity, such as urinary tract and skin jections must be repeated a few times a year. These breakdown. Check to see if any of the common injections can be used alone or in combination with triggers listed above may be causing the problem. oral spasticity medications.

Spasticity and Spinal Cord Injury Page 2 of 3 Which treatment is best for me? . Intrathecal medication therapy (also Discuss your specifi c needs and treatment options called a “pump” or “baclofen pump”) with your health care provider or team. You may Intrathecal drug therapy uses a surgically placed, need to try different methods, medications, or battery-powered pump and an attached catheter combinations of treatments before you feel your to deliver medication directly into the spinal canal, spasticity is under control. Consider the following around the spinal cord (called the “intrathecal” questions and discuss them with your provider: space). The most commonly used intrathecal drug . What are your goals for treatment of your for spasticity is baclofen. Intrathecal baclofen can spasticity? be used in conjunction with the other treatments . How important is it that the treatment can be listed above. This treatment is generally not rec- reversed or stopped? ommended until other treatments have been tried . What are the possible short-term and long-term and failed to provide relief or if oral medications side-effects of each treatment? cause unacceptable side effects. Advantages of intrathecal baclofen: . Are there other health conditions that would • The drug is delivered directly around the spinal infl uence the treatment choice? cord, so lower doses of medication are needed. . If you are considering intrathecal baclofen: Will • Fewer negative side effects because the drug you be able to follow the maintenance require- does not enter the bloodstream. ments? Do you have a good understanding of • The amount and dosing schedule of drug the possible risks and benefi ts? throughout the day can be precisely set and Whatever treatment you choose, you will need adjusted by the health care provider to meet to work closely with your treatment provider or each individual patient’s needs. team to get the best possible outcome. • The pump can be stopped or removed, if nec- essary. What happens to spasticity over time? Disadvantages of intrathecal baclofen: In general, spasticity appears to become less both- • You will need surgery to implant the pump and ersome over time. Possibly this happens because catheter system. Any surgery has risks, such as people learn to avoid things that trigger spasticity. infection. Changes that naturally go on in the body as you • The pump has a limited battery life and will age, such as a slowing down of nerve conduction, need to be replaced about every 5-7 years. may also decrease spasticity. However, an unex- • You will need to go to your provider periodi- plained, sudden or dramatic change in your spas- cally for pump refi lls (done by injecting baclofen ticity level may sometimes signal a problem, so let through the skin into the pump reservoir). your health care provider know immediately. Mechanical problems with the device may occur Source and could result in a baclofen overdose or under- Our health information content is based on research evi- dence whenever available and represents the consensus of dose. For this reason, it is important for you to expert opinion of the SCI Model System directors. understand the risks, monitor yourself carefully, and get regular follow-up from your provider. Authorship Spasticity and Spinal Cord Injury was developed by Maria R. . Other Surgery Reyes, MD and Anthony Chiodo, MD, in collaboration with Other surgical treatments for spasticity are far the Model Systems Knowledge Translation Center. less commonly performed because they are not Portions of this document were adapted from materials devel-

Spinal Cord Injury Model Systems Consumer Information oped by the University of Michigan and UAB Model Systems. reversible. These include cutting a section of the spinal cord (myelotomy) or nerve roots (rhizoto- Disclaimer my), or lengthening and transposing a . Your This information is not meant to replace the advice from doctor will discuss these surgical options with you a medical professional. You should consult your health care provider regarding specifi c medical concerns or treatment. if necessary.

Spasticity and Spinal Cord Injury Page 3 of 3