Tuesday, August 26, 2014

Spasticity I: The "Magic" "Cure" for Spasticity Reduction?


Why do I have spasticity? What can I do to get rid of spasticity? When will it go away?"
        People who have any number of pathologies can suffer from spasticity. Spinal cord injury, multiple sclerosis, amyotrophic lateral sclerosis (Lou Gehrig's disease) and other pathologies have spasticity as a sequela. This column will discuss spasticity as it relates to acquired brain injury which includes traumatic brain injury, cerebral palsy and stroke.
     Most clinicians provide patients with overly simplified, incomplete and often inaccurate information about what spasticity is, its etiology and its cure. Therapists generally believe that patients don't want detailed explanations. But patients need to understand their spasticity. Why? Having patients understand their spasticity is essential because spasticity will only reduce if executive control over the spastic muscles, by the brain, is restored. And executive control over muscles will only happen with repeated firing of the muscle in question, and repeated firing will only happen if the patient wants it to happen.


oc1dean said...

And I still hate Dr. William M. Landau for setting back the research into spasticity because he must have never talked to an intelligent patient that had spasticity. Schadenfreude will be coming.

Dogon Sirius said...

Trouble is, The only exercise I can do with my left hand is stacking three cups - a few reps of this either increases the spasticity or I lose the ability to hold the cup, so I can't repeat this for long before needing a rest (in fact the whole arm gets exhausted). Sending the signal in to my hand to move the fingers seems to increase the contraction: If my hand is relaxed I can wedge a ps3 or xbox 360 controller in there. Once my thumb rests on the stick control is miraculously restored - for a second or two I can move my thumb and the stick around, but this instantly triggers a massive contraction and I can't hold the controller anymore. Any suggestions? BTW, standing qigong - specifically, 20-30 min in Zhan zhuang Wu Chi position - helped me to relax my arm at my side again.

Hey Peter? Thanks for the book and for the blog. Keep up the good work.

Peter G Levine said...

Dogon, you have a point. This idea of spasticity reduction through repetative practice is only in play if sufficient repetitions can be done. It is also true that volitional movement-especially difficult volitional movement- will temporarily increase spasticity in much the same way stretching will temporarily decrease spastcicty. But the focus should be the long term. Dont be confused about what happens now...its the long term that matters. Perhaps the "cups exercise" does not garner enough repetitions but some other exercise may. I'd suggest something that passively opens the hand that allows you to squeeze repeatedly. Thanks, -pete

Dogon Sirius said...

Follow up question: should I be using metal spring grip strengtheners? So far I've been using small foam footballs and similar nerf type things for gripping - hard enough to do with my weak hand, a spring gripper is near impossible to budge, but should I be working on that anyway, to "get the strength back"? I know from previous experience that grip training that pumps up the forearm can seriously hinder wrist flexibility, and mine is bad enough as it is, but does strength in some way equal amount of brain signal getting through? or is it better to squeeze things that I can mash with my good hand but have to work at with my stroke hand, increasing the signal through repetition? See what I'm getting at? Thanks.

Dogon Sirius said...
This comment has been removed by the author.
Peter G Levine said...

Dogon, use anything you can to squeeze the hand closed. The idea is not to build muscle, it it to get enough hand flexion to reestablish brain control over spastic muscles. Good luck!

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