spasticity

[Kristina1]

I had a clinic visit yesterday and my neuro had a resident shadowing her. With my permission, she did her neuro exam out-loud to show/teach the resident. Most of the things she showed the resident I was already aware of (atrophy, fasiculations, jaw jerk, hoffman's, babinski, hyperreflexia, clonus etc). But she kept mentioning spasticity- she said I have spastic speech, spasticity in my arms, and spastic gait.

I don't really understand what that means. Can anyone explain it to me?

As an aside, even though this was basically all stuff I knew about, it was disturbing to hear it pointed out and discussed out loud. Normally she silently does the exam and writes her notes without sharing them.

 

[KarenNWendyn]

Kristina,

Spasticity is an upper motor neuron sign and refers to an increase in muscle tone that the neurologist can detect on exam. I like to think of it as analagous to a tightly wound up spring. Others may have better explanations.....

In terms of the attending physician bringing medical students and residents in to observe the exam .... that’s pretty standard at academic medical centers. It helps the newby docs learn by seeing abnormal or unusual findings. I always appreciated it during my medical training and don’t mind it now that I’m a patient. However, not all patients appreciate being on display. Your doctor should ask if it’s ok with you before they bring in another doctor to observe. If you’d rather not, you can tell them it makes you uncomfortable. If they don’t ask, let them know afterwards, or ask your husband to say something.

 

[ShiftKicker]

Spasticity indicates your muscles are not always getting the correct signals from the brain- or are getting conflicting and inappropriate signals- when you set them to a task. Where Lower Motor issues mean your muscles are getting NO signals, Upper Motor issues indicate all sorts of signals are making it to your muscles, but they are not always organized or appropriate. When you are at rest, your muscles continue to get static that prevents them from relaxing. Everything takes more effort. There is less control. Not all the muscles needed for a particular task get the correct signal.

Spasticity was described to me as the motor cortex in the brain sends a whole lot of static along with the normal instructions your muscles get in order to do a task. Your brain also gets feedback from those muscles constantly in order to do things like maintain balance, know how much force to use, how far to reach to touch an object and all the millions of little things that happen in order to respond to your environment. If the signals are being interfered with, your muscles can "catch" or respond slowly and incompletely.

I hope that all makes sense. I am sure there are people here who can provide a more formal and medical description of what spasticity is.

 

[affected]

Tightly wound spring is a good description.

Those PALS with UMN symptoms have the pain, and it's due to this increased tone as muscles waste. We see joints freezing and fingers and even toes curling in.

Those with little UMN become like floppy dolls and don't have the pain.

Then as Kim says the signals are not getting through and it's like lots of static. To do anything there are 2 opposite muscles working, one contracting and one stretching. They are getting mixed signals because of all the 'static' and so it's like they are both contracting or both stretching and the movements become jerky and uncoordinated.

Baclofen works by reducing that static and often the resulting reduction in tightness causes the underlying muscle weakness to become suddenly very apparent as it was masked by the tightness. Baclofen doesn't make you weaker, it just unmasks the weakness.

Hope that all helps!

 

[Kristina1]

Thanks these explanations make a lot of sense and jive with my experience. My fingers are curling, I often poke myself in the eye, I shake/tremor too much to do things like apply make up, I have bad fine motor control so my writing is terrible and I struggle to get my finger to accurately hit the right keys on my cellphone keyboard. My feet are definitely too springy when walking, they kick out. I did not realize a single term encompassed all those various things. Thanks for explaining.

My neurologist did ask my permission about having the resident there and including her in the exam, and I was and still am fine with it. I just didn't realize how scary/intimidating it all sounds pronounced out loud in medical speak. But now I know what to expect and if it happens again I won't be so caught off guard by all the jargon.

 

[affected]

I'd also like to thank you for allowing that teaching opportunity for that resident - the more that learn a lot about ALS the better!

Quite often that would be me in the hospital explaining it to the health professionals on general wards when we would land in there

 

[Flpopsi]

My wife was on Baclofen and it didn't help and seemed to make her weaker. If I understand you correctly, the spasticity and tightness in her muscles gives the appearance of muscle strength but it hides or masks the underlying weakness. If this is correct, Baclofen should reduce the spasticity but the real weakness of the muscles will present themselves. Is Baclofen good or bad? My wife is at the point of no use of her right hand and arm, limited in her left hand, not able to walk without assistance, no voice and difficulty swallowing. She has a tremendous amount of stiffness and cramping throughout her body. She no longer sees a neurologist. Any suggestions for her pain and to make her more comfortable.

 

[lgelb]

Florida, did your wife try tizanidine? It has a different mechanism of action than baclofen.

 

[affected]

tizanidine is often reported as effective, and daily massage and ROM can assist a lot. I would massage and then rub in magnesium oil which was very effective.

 

[Firefighter58]

I take both Baclofen and Tizanidine three times a day and find it very helpful.
Al

 

[Flpopsi]

Thank you for your replies. I have followed up with her Nurse Practitioner about Tizanidine and will start massages.

 

[lgelb]

A low-voltage heated mattress pad can be placed under the mattress or sheet, as well, as well as a heated (self- or electric) throw wherever she sits. Not a cure-all but can be soothing esp. in winter.