SPASTICITY.docx
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The document discusses spasticity, its causes, and various treatment approaches. It defines spasticity as increased muscle tone caused by damage to upper motor neurons. Two treatment approaches are described - the Bobath technique which facilitates normal movement patterns to reduce excessive muscle activity, and the Rood approach which uses sensory stimulation and motor patterns to influence muscle tone. Finally, common inhibition techniques are outlined which apply sensory input to muscles to reduce hyperactivity and promote relaxation.
SPASTICITY.docx
- 1. Bangladesh Health Professions Institute Department of Occupational Therapy Masters of Science in Occupational Therapy Occupational Therapy in Adult Neurology Spasticity Spasticity is a neurological condition characterized by increased muscle tone, stiffness, and involuntary muscle contractions. It is caused by damage to the upper motor neurons in the brain or spinal cord, disrupting the normal balance of signals between the brain and the muscles. The mechanism of spasticity involves several interconnected factors: 1. Upper Motor Neuron Damage: The primary cause of spasticity is damage to the upper motor neurons. These neurons are responsible for transmitting signals from the brain's motor cortex to the spinal cord, where they synapse with lower motor neurons that control muscle movement. Damage to the upper motor neurons can occur due to conditions such as stroke, traumatic brain injury, multiple sclerosis, cerebral palsy, or spinal cord injury. 2. Loss of Inhibitory Control: In a healthy nervous system, upper motor neurons not only activate muscles but also have inhibitory connections that prevent excessive muscle contraction. When these inhibitory connections are disrupted due to the damage, there is a lack of control over the muscle's excitability, leading to increased muscle tone and spasticity. 3. Hyperactive Stretch Reflex: The stretch reflex is a normal protective mechanism that occurs when a muscle is rapidly stretched. In spasticity, the stretch reflex becomes hyperactive, causing an exaggerated and involuntary muscle contraction in response to minimal stimuli. This leads to muscle stiffness and resistance during movement. 4. Imbalance in Muscle Activation: With spasticity, there is an imbalance in the activation of agonist and antagonist muscles. Agonist muscles are responsible for a specific movement, while antagonist muscles oppose that movement. In spasticity, the agonist muscles may become overly active, while the antagonist muscles may not be sufficiently engaged, resulting in abnormal movement patterns and difficulties in coordinating voluntary movements. 5. Development of Contractures: Prolonged and severe spasticity can lead to the development of contractures, which are permanent shortening of muscles and tendons. Contractures can further restrict joint movement, exacerbating the functional limitations caused by spasticity. 6. Spinal Reflex Loops: In addition to the hyperactive stretch reflex, other spinal reflex loops may also contribute to spasticity. These reflex loops can cause abnormal patterns of muscle activation, further exacerbating muscle stiffness and involuntary movements. The severity of spasticity can vary from mild to severe, depending on the extent of upper motor neuron damage and individual differences. The specific symptoms and affected muscles may differ based on the
- 2. underlying condition causing spasticity. Effective management of spasticity involves a multidisciplinary approach, including physical therapy, medications, and other interventions, to reduce muscle tone, improve function, and enhance quality of life. The Bobath Technique The Bobath Technique, also known as Neurodevelopmental Treatment (NDT), is a specialized approach used in physical therapy and occupational therapy to address neurological conditions, including spasticity. It aims to improve functional movement, reduce abnormal muscle tone, and enhance overall motor control. While the Bobath Technique does not directly target spasticity reduction, its principles can help manage spasticity-related issues and improve functional abilities. Here are some ways the Bobath Technique can indirectly contribute to reducing spasticity: 1. Facilitation of Normal Movement Patterns: The Bobath Technique emphasizes facilitating normal movement patterns and inhibiting abnormal movement patterns. By promoting more natural and efficient movement strategies, the technique can help reduce the excessive muscle activity associated with spasticity. 2. Use of Inhibition Techniques: The Bobath Technique incorporates inhibition techniques to reduce spasticity. Therapists use gentle handling and positioning to calm the nervous system and reduce hyperactive reflexes, thus helping to lower muscle tone. 3. Promotion of Muscle Lengthening: Stretching and positioning techniques used in the Bobath Approach can help lengthen muscles, preventing or minimizing the development of contractures associated with severe and long-standing spasticity. 4. Weight Bearing and Weight Shifting: Weight-bearing exercises and weight shifting activities are an essential part of the Bobath Technique. These activities can promote the appropriate activation of muscles and sensory feedback, contributing to improved motor control and potentially reducing spasticity. 5. Incorporation of Postural Control: The Bobath Approach emphasizes postural control to achieve functional movements. By enhancing postural stability, individuals with spasticity can have better control over their movements and potentially experience reduced spasticity during functional activities. 6. Task-Specific Training: The Bobath Technique incorporates task-specific training, where individuals practice functional tasks relevant to their daily lives. This approach can improve motor learning and help individuals overcome spasticity-related challenges during functional activities. It's important to note that while the Bobath Technique can help manage spasticity indirectly, it may not be the primary method for reducing spasticity itself. Other interventions, such as medications (e.g., muscle relaxants), botulinum toxin injections, or surgical interventions, may be required for more direct spasticity management. A comprehensive treatment plan, developed in collaboration with a multidisciplinary team, is usually the most effective approach to address spasticity and its impact on an individual's functional abilities and quality of life. If you or someone you know is experiencing spasticity, it's essential to consult
- 3. with healthcare professionals, such as physical therapists, occupational therapists, or neurologists, to determine the most appropriate and individualized management plan. The Rood Approach The Rood Approach, also known as the Rood Technique or Rood Method, is a therapeutic approach used to manage spasticity and other neuromuscular disorders. It was developed by Margaret Rood, a pioneering occupational therapist, and is based on the idea that specific sensory input can influence muscle tone and motor responses. The Rood Approach primarily focuses on using sensory stimulation and motor patterns to influence muscle activity and improve motor control. Here are some key components of the Rood Approach in managing spasticity: 1. Sensory Stimulation: The Rood Approach employs various sensory inputs to modulate muscle tone and reflex activity. These sensory inputs include techniques such as stroking, brushing, and tapping the skin to activate or inhibit specific muscle groups. 2. Rhythmic Initiation: Rhythmic initiation involves gradually increasing the range and intensity of a movement in a smooth and rhythmic manner. This technique aims to promote muscle relaxation and reduce spasticity by facilitating voluntary muscle control. 3. Rhythmic Rotation: Rhythmic rotation is a technique in which a therapist moves a joint in a rotational pattern while maintaining a constant speed and force. This technique is used to reduce hypertonia (increased muscle tone) and increase muscle relaxation. 4. Reciprocal Inhibition: Reciprocal inhibition involves the activation of the antagonist muscle to the spastic muscle group to induce relaxation in the spastic muscles. For example, if the biceps muscle is spastic, the triceps muscle is activated to inhibit the biceps' activity and promote relaxation. 5. Heavy Work: Heavy work refers to activities that require significant muscle effort and exertion. Engaging in heavy work can help reduce spasticity by promoting normal muscle activation and sensory feedback. 6. Tapping and Vibration: The Rood Approach may use tapping or vibration techniques to provide sensory input to muscles and joints, influencing muscle tone and reflex responses. 7. Verbal and Visual Cues: Verbal and visual cues are often used to facilitate motor responses and enhance functional movements. These cues can help individuals with spasticity better coordinate their movements and improve motor control. It's essential to note that the Rood Approach is just one of many therapeutic approaches used to manage spasticity. Each individual's response to therapy can vary, and the Rood Approach may not be suitable for everyone. The management of spasticity often requires a comprehensive and individualized treatment plan, which may include a combination of therapies, medications, and other interventions based on the underlying cause and the individual's specific needs and goals. If you or someone you know is experiencing
- 4. spasticity, it's crucial to work with healthcare professionals, such as occupational therapists, physical therapists, or neurologists, to determine the most appropriate and effective treatment approach. Inhibition techniques Inhibition techniques are used to reduce spasticity by calming overactive reflexes and reducing muscle tone. These techniques focus on providing sensory input to the muscles and nervous system in specific ways to promote relaxation and decrease muscle hyperactivity. Here are some common inhibition techniques used for managing spasticity: 1. Stretching: Gentle and sustained stretching of spastic muscles can help lengthen the muscle fibers and reduce muscle tone. Stretching should be performed carefully to avoid triggering the stretch reflex excessively. 2. Prolonged Pressure: Applying prolonged, firm pressure to a spastic muscle or its tendon can help reduce muscle tone. This technique, known as prolonged pressure or deep pressure, can be achieved using hands, elbows, or therapeutic tools. 3. Weight Bearing: Weight bearing involves applying pressure or bearing weight on a spastic limb, which can help decrease muscle tone and promote better alignment and control of movements. 4. Neutral Warmth: Applying a warm, moist compress or using warm water during hydrotherapy can have a relaxing effect on spastic muscles. 5. Neutral Warmth: Applying a warm, moist compress or using warm water during hydrotherapy can have a relaxing effect on spastic muscles. 6. Slow, Deep Tapping: Slow, deep tapping (also known as rhythmic tapping) on the skin overlying spastic muscles can help stimulate the Golgi tendon organs, which leads to reflex relaxation of the muscle. 7. Rocking: Gentle rocking movements can be used to encourage relaxation and reduce muscle tone. This technique is often applied to the whole body while the person is in a comfortable and supported position. 8. Slow Rolling: Slowly rolling or rocking a body part can help decrease spasticity and promote relaxation of the involved muscles. 9. Facilitation of Inhibition Responses: Providing sensory input to specific areas of the body or specific muscles can trigger inhibitory responses and reduce muscle tone. For example, applying gentle pressure or touch to certain points on the body may help induce relaxation. 10. Inhibitory Casting or Splinting: Customized splints or casts can be used to position spastic limbs in a way that promotes relaxation and reduces muscle tone over time.
- 5. It's important to note that while inhibition techniques can be helpful in managing spasticity, their effectiveness may vary among individuals. Furthermore, a comprehensive approach to spasticity management often includes a combination of therapies, medications, and other interventions based on the individual's specific needs and the underlying cause of spasticity. Healthcare professionals, such as physical therapists, occupational therapists, or neurologists, can provide guidance on selecting the most appropriate and effective inhibition techniques for managing spasticity.