A stroke is caused by either a blockage of a blood vessel or bleeding in or around the brain, which results in a lack of oxygen to the brain and the death of brain cells.

Spasticity and Stroke

Stroke and Brain Function
A stroke is caused by either a blockage of a blood vessel or bleeding in or
around the brain, which results in a lack of oxygen to the brain and the death
of brain cells.

In the simplest terms the brain receives messages, process messages, and sends
messages. Each area of the brain is responsible for different things. Depending
on the area of the brain that was damaged will determine which messages are
interrupted.

If the area of the brain that was damaged was the signal to send a message to
your bicep and/or tricep muscles (the muscles that bend and straighten your
elbow), you might experience tightness of those muscles due to spasticity.

What is Spasticity?


Spasticity is essentially a reflex. Reflexes are our bodies way of protecting
ourselves. When we touch a hot stove with our hand, our muscles immediately
contract to move our hand out of harms way. This message is not actually coming
from the brain. It would take too long for the signal to go from the skin to the
brain, process it, and send a signal back to the muscle to move away from the
hot object. The pain message from the skin goes to the spinal cord and sends a
signal right away to the muscle to contract. Once the hand is moved away from
the harmful surface the brain has had enough time to process if it is safe for
the muscle to relax, and is able to send a signal to relax the muscle.

In it's truest definition, spasticity occurs in response to quick movement: if
your elbow is quickly extended, it will pull into flexion. This reaction is a
symptom that the brain to muscle messaging system is impaired. But spasticity
and increased tone are also used as general terms to describe any tightness of
muscles that result from damage to the brain or spinal cord. Meaning when the
tightness of a muscle occurs without the quick stretch, such as posturing the
arm in flexion or a muscle tightening during an activity, this is often referred
to as spasticity as well.

What happens after a stroke is that the brain has difficulty sending a signal to
the muscle to relax. Sometimes the message is absent and there is no active
signal and sometimes the message to relax is weak. This is why some people might
tighten when they are running or during an activity. Their brain is working hard
on sending signals to the rest of the body, it doesn't have the time to work on
sending a signal to relax the muscle.

Managing Spasticity
It’s important to note that not all spasticity is bad. Many people with stroke
use their spasticity to assist with standing, transfers, and daily activities.
It’s important to discuss options for managing spasticity and functional
implications with your physician and your occupational or physical therapist.

There are two general approaches that address spasticity: medical management and
physical management. Medical management is decided in collaboration with the
patient and physician. It addresses the neural component that is causing the
muscle tightness. Medical management of spasticity includes oral medications,
neurotoxin or phenol injections, and surgical interventions.

The physical management is typically addressed by a physical or occupational
therapist and addresses the biomechanics of the joint to prevent muscle
shortening, joint deformities, and decreased function. Physical management
includes stretching, muscle strengthening, and intensive repetitions. Physical
and occupational therapists also use electrical stimulation
[https://www.neofect.com/us/blog/can-e-stim-help-jumpstart-outpatient-stroke-rehabilitation] 
and ice as modalities to limit spasticity during exercise or functional
activity.

STRETCHING

Spasticity tightens our muscles and over time the muscle begins to shorten. This
limits our ability to move our joints even further. Stretching has the potential
to quiet the hyper exaggerated reflex for several hours, as well as the benefit
of maintaining range of motion. Stretches should be held for 30 seconds or more
and you may feel a release of the muscle tone.

Splinting and orthotics are used for an even longer stretch. They position a
joint optimally to maintain length of a muscle and prevent contractures.
Depending on the purpose, splints and orthotics are worn during the day or at
night to allow for hours of stretch time.

Weight-bearing is a form of prolonged stretching with the added benefits of
strengthening and increasing bone density. After a stroke the motor function of
the leg tends to return before the arm, and one of the reasons may be the
motivation to walk and the intensive weight bearing of the leg. When we weight
bear or put pressure on our muscles and joints, we are sending signals to the
brain. The brain is getting a lot of feedback from that extremity. Any weight
bearing of the upper extremity either at the wall, table, or floor helps sends
signals to the brain that reminds it the arm is still there.

STRENGTHENING

Strengthening can improve spasticity in two ways. By strengthening the
antagonist (opposing) muscle, it can help inhibit the reaction of the spastic
muscle. When the spastic muscle activates and tries to pull a joint into
flexion, the extensor muscle has the capacity to limit the flexion just by being
stronger.

We must also strengthen the spastic muscle. It might seem that with all that
contracting a spastic muscle would be a strong muscle, but without the brain to
muscle connection a spastic muscle is actually a weak muscle. Utilizing
electrical stimulation or ice prior to strengthening a spastic muscle may be a
way to optimize your strengthening session.

Strengthening can happen any time a muscle is contracted, but depends on the
capability of the person doing the contracting. It has to be somewhat difficult.
The muscle has to fatigue. The person who does not have full active range of
motion, but is able to visibly contract a muscle is strengthening with each
repetition of movement.

Repetition of movement is a rehabilitation strategy not only for strengthening,
but plasticity. Intensive repetitive training or massed practice is the key to
neuroplasticity and improving the way the brain sends signals to the muscles.

INTENSIVE REPETITIVE TRAINING

Voluntary movement has the potential to maintain joint range of motion,
strengthen, and increase plasticity
[https://www.brainhq.com/brain-resources/brain-plasticity/what-is-brain-plasticity/]
. But it’s all about repetition. In a typical therapy session, you might expect
to do 20-30 repetitions of movement. You would be responsible for completing the
movements for each joint on a daily basis. This can become boring and the habit
slowly slips away.



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Every person is unique and has a different rehabilitation journey. Neofect has
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you.

If you've had a stroke and are looking for an effective solution for your
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To learn more, please call (866) 534-4989 or email contactus@neofect.com.

For more information on stasticity and stroke:
American Association of Neurosugical Surgeons - Spasticity
[https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Spasticity]
National Institute of Neurological Disorders and Stroke - Spasticity
Information
Page
[https://www.ninds.nih.gov/Disorders/All-Disorders/Spasticity-Information-Page]
Cleveland Clinic - Spasticity
[https://my.clevelandclinic.org/health/diseases/14346-spasticity]

National Stroke Association - What is Stroke
[https://www.stroke.org/understand-stroke/what-is-stroke/]
Mayo Clinic - Stroke Symptoms and Causes
[https://www.mayoclinic.org/diseases-conditions/stroke/symptoms-causes/syc-20350113]
Stroke Association - About Stroke
[https://www.strokeassociation.org/en/about-stroke]

All content provided on this blog is for informational purposes only and is not
intended to be a substitute for professional medical advice, diagnosis, or
treatment. Always seek the advice of your physician or other qualified health
provider with any questions you may have regarding a medical condition. If you
think you may have a medical emergency, call your doctor or 911 immediately.
Reliance on any information provided by the NEOFECT website is solely at your
own risk.