Spasticity / Contracture
What is Spasticity?
Spasticity is defined as an involuntary, velocity-dependent, increased resistance to stretch. This definition means that the amount of resistance to stretching is partly determined by the speed with which a spastic muscle is stretched, and manifests as pain, tightness, or posturing
What is a Contracture?
Fixed resistance to passive stretching of a joint due to shortening or wasting (atrophy) of muscle fibers, tendons, or the development of scar tissue (fibrosis) of the joints.
Causes of Spasticity
The most common causes of spasticity are lack of oxygen to the brain before, during, or after birth (cerebral palsy); physical trauma (brain or spinal cord injury); blockage of or bleeding from a blood vessel in the brain (stroke); and multiple sclerosis (MS). When the damage that causes the eventual spasticity first occurs, the muscles are usually flaccid before they become spastic. Spasticity may not be present all the time—it may be related to a trigger, or stimulus, such as pain, pressure sores, a urinary tract infection, ingrown toenails, tight clothing, or constipation.
Spasticity and contractures are symptoms commonly experienced in many different diseases that can affect the nervous system. Therefore, the treatments have to be tailored specifically for each individual patient depending on their underlying ailment, their level of independence, their individual goals, and care setting.
The initial assessment and treatment are dependent on the severity of the spasticity, which limbs are affected, the amount of tendon shortening, and any joint abnormalities. Generalized therapy includes treatment with oral medications, or with implantable devices that deliver medicine directly into the spinal canal. Isolated therapy includes injections, particularly with botulism toxin and tendon stretching.
Occasionally, patients with severe spasticity or contractures will have difficulty making further progress with no operative treatments. For these patients, surgery can be very helpful.
Surgery can be a very powerful tool to “unlock” the functional potential of a patient that is being overpowered by spasticity or contractures.
This program applies a team approach to treating spasticity and contractures. The combination of dedicated physical/occupational therapists, neurologists, orthopedic/neurological surgeons, and orthotic specialists, all with different but complementary skills and experiences, ensures the best possible outcome.
Dr. Simon Fishman
Dr. Simon Fishman is board certified by the American Board Of Neurology and Psychiatry and the American Board of Neuromuscular and Electrodiagnostic Medicine. He has extensive experience with movement disorders, neuromuscular disease, rehabilitative neurology, stroke, degenerative neurological disorders, and therapeutic use of Botox and Baclofen.
Dr. Fishman has been practicing general neurology, since July 2000, in Northern Virginia with admitting privileges at Inova Fairfax and Alexandria Hospitals and Mount Vernon Hospital.
- Medtronic ITB Therapy (Intrathecal Baclofen Therapy)
- Personal Stories – Medtronic ITB Therapy
- Upper Extremity Spasticity – Henry Winkler (Fonz) Interview