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Spasticity Management

Spasticity is a type of muscle stiffness that can occur as a result of damage to the spinal cord or brain, and it is a common symptom in people with stroke, multiple sclerosis, cerebral aneurysms, brain and spinal cord trauma, tumors, and hypoxia (a lack of oxygen). Spasticity can be seen by itself, but it occurs more often in conjunction with weakness, pain, poor coordination, or loss of feeling.

Spasticity can have a profound effect on the lives of those with brain and spinal cord injuries. Often, stiffness makes it difficult to walk, eat, dress, bathe, transfer in and out of bed, or go to the bathroom. Sometimes, particularly in patients with spinal cord injury or multiple sclerosis, spasticity can result in painful spasms in the thighs and legs.

The diagnosis of spasticity usually requires no special equipment. A physician specializing in neurological surgery, neurology, or rehabilitation medicine can make the diagnosis simply by examining a patient. In cases of severe spasticity where joints are nearly "frozen", the diagnosis can be more difficult.

Once a patient explains his or her symptoms, rehabilitation physicians, occupational therapists, and physical therapists work together to determine which muscles are causing the most difficulty. This usually is done by observing a person walk or perform or simulate daily activities, or by reviewing a detailed description of a patient?s daily difficulties. Videotaping everyday activities also is helpful in determining which muscles are most affected.

In many cases, spasticity can be managed effectively with a variety of treatments. If many muscle groups are involved, oral medications can be beneficial. When the condition involves a few muscles in one or two limbs, a variety of injections can be used, such as botulinum toxin or a chemical called phenol. Severe spasticity involving both legs or an arm and a leg, or that does not respond to oral medication, could benefit from a treatment called an intrathecal baclofen pump. This kind of pump, which is implanted in the body, can administer medication continuously to the cerebrospinal fluid that surrounds the spinal cord. Physical and occupational therapy compliment many treatment approaches.

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