What makes them flare at times worse than others? Does it get worse before it gets better? Or does worsening spasticity just mean you're going downhill?
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Specificity is very interesting and a little complicated, so try to make it a little simpler. So, spasticity is involuntary movement of a muscle and it's in response of a stretch which causes tightness. So, the muscle remains contracted and it doesn't shut off. It is resistive to being stretched so when you try to stretch someone out it locks up. That pretty much happens when the signals in the brain are just not communicating to the muscle to turn it off. The movements are just not fluid, there's a lot of stiffness, and it can cause pain and discomfort. Spasms are a component of spasticity so spasms are involuntary tightness or a quick or prolonged contraction in one or more muscle group. They range from small muscles or larger muscles- you can get them in their hand or even in your leg for some other disorders like MS. You might have involuntary moves and spasms in your upper body, your lower body, or your legs, but really spasticity is based on damage in the brain and how severe it is. It can be worse sometimes and sometimes it just really depends on movement. If you're moving the limb quickly, then the spasm or the spasticity will be stronger. A lot of times when I see patients I’ll see how people have more of that spasticity in their hand or their arm when they start to walk. When they're doing an activity, it starts to get really strong and they go into this flexure like a flexion pattern. Hopefully, it will get better once the brain is healing and over time, but there are some ways to decrease spasticity. We like to try to reiterate relaxing the arm as much as possible, trying to train the brain to try to relax your muscle group that is contracted or not contracted but stiff in that particular position. Also, talk to your doctors. There's also medications that can help with spasticity. There's one that's popular called baclofen that people get to help with specificity and spasms. They also have things like muscle relaxers that can help with that but it really depends on the diagnosis and depends on if you have any core mobilities. If you're able to take those medications, follow up with your doctor. Another thing that is important is just range passive range of motion of wherever that extremity is, just to prevent it from getting super tight and you losing range of motion as we don't want that. Another thing that you can also do is some splinting if you have an OT working with you. There's also things called focused rigidity casting which is a cast that you can put on and take off that can be made for you. Say you want to put it on the elbow. You can use that and you can measure it and have the person in that cast for night time. Usually, they'll just have it at night time or you can do in the daytime. It gives them a stretch so their arm can relax for a little bit and then you can make another one as needed to increase range of motion in the arm or leg. There's also cereal casting which is a cast that actually stays on for like a week and then they saw it off. That is useful too and has good benefits to increase range of motion. Additionally, if it is severe enough and it's really bad, you can also do botox injections which can help. Then if it's really really severe, which I don't want to get too much into, you can also get a baclofen pump inserted where you get the medication all the time to help with spasticity.