These synergistic patterns can appear as both a static positioning of an affected limb and a nonspecific movement pattern. Lower limb extension synergy consists of hip extension, adduction, internal rotation, knee extension, ankle plantar flexion, inversion, and toe plantar flexion. In the lower limb, flexion synergy consists of hip flexion, abduction, and external rotation, along with knee flexion, ankle dorsiflexion, and inversion. Conversely, upper extremity extension synergy is characterized by simultaneous shoulder adduction and elbow extension. In the upper extremity, the flexion synergy is often characterized by simultaneous shoulder abduction and elbow flexion. Motor synergies are stereotyped movements of the entire limb that reflect loss of independent joint control and that limit a person’s ability to coordinate his or her joints in flexible and adaptable patterns, thereby precluding performance of many functional motor tasks. Given this common practice, spasticity and muscle overactivity are used somewhat interchangeably for remainder of this chapter.įlexion (the movement of a limb to decrease the angle of a joint), extension (the opposite movement) or combined flexion–extension synergies can be observed. Frequently, and perhaps unfortunately, the term spasticity is often applied to the entire collection of signs. ![]() Collectively, all of the positive signs can be called “muscle overactivity,” with the qualification that abnormal pathology extends beyond the muscle itself. Spasticity is only one of these features, namely, a velocity-dependent increase in resistance to passive range of motion (ROM). Observable phenomena include increased resistance to passive stretch, muscle–tendon hyperreflexia, clonus, co-contraction of synergistic muscle groups, and spontaneous flexor–extensor spasms. The positive components are more complex, with diverse pathophysiologic mechanisms. Other negative signs include atrophy, fatigability, and loss of selective motor control. Weakness and loss of dexterity, the most commonly encountered negative phenomena, are relatively easy to define. ![]() Pathologic changes in the central nervous system often create a constellation of symptoms or signs that encompass both positive and negative components. ![]() In addition, spasms associated with spasticity can cause pain, interrupt sleep, negatively influence mood, and impair mobility. For example, relatively slight resistance to passive motion, evaluated as “mild” by a physician, may have a quite significant functional impact for a patient, who might describe the same phenomenon as “severe.” Even mild degrees of spasticity can impair the ability to perform basic activities of daily living, including hygiene, dressing, and toileting. However, clinicians must use caution when applying such descriptors of severity to muscle overactivity so as not to misrepresent their clinical impact to the patient. The condition can be mild, with patients experiencing only minor discomfort or inconvenience, or major, with the spasticity leading to immobility and the development of contractures and pressure sores. Lance described it as “a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes with exaggerated tendon reflexes, resulting from excitability of the stretch reflex.” It can also be defined as the constant and unwanted contractions of one or more muscle groups as a result of an injury or insult to the brain or spinal cord. Medication management such as Botox or Baclofen (please speak to your physician if you are interested in this option)įor upper extremities with little to no movement, inventions like splints and the Neurolutions brain-computer interface IpsiHand system can be effectively paired with traditional therapy with the occupational therapist to address activities of daily living, family training, use of adaptive equipment, and the use of one-handed techniques with the use of assistive devices.Spasticity is a commonly encountered condition that can have a devastating impact on affected patients. Inhibition techniques that serve to stretch and position muscles and joints in more optimal alignment and for reducing signals that promote over-excitement of neural firing Focus on trunk and extremity positioningĮlectrical stimulation (combined with function or used to relax the spastic muscle groups) placing pressure through an aligned joint to activate/contract the muscle) constipation, UTIs, extreme hot or cold temperatures) ![]() Education on common noxious “triggers” that contribute to heightened spasticity and synergy patterns (i.e.
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