Get rid of spasticity after a stroke. How to get rid of spasticity after a stroke? Signs of seizures after a stroke

Stroke is one of the most pressing problems of modern medicine. High percentage of mortality and loss of performance, tendency to form

Persistent residual effects and frequent damage to patients of working age are the main points that explain the need to develop effective preventive and treatment measures.

Movement disorders are the most common consequence observed in patients after a stroke. The greatest chances of recovery are observed during the first months. It is during this period that many patients after a stroke develop muscle hypertonicity, which significantly complicates rehabilitation.

Development mechanism

To better understand the mechanism of development of muscle hypertonicity, let's consider the main aspects of movement regulation.

The earlier classes to prevent spasticity begin, the better the result.

Normally, muscle contractions are regulated at three levels:

spinal cord;
stem nuclei of the brain;
cortex.

Any of these sections can stimulate muscle contraction. Thanks to the close cooperation of these departments, a person can perform the necessary movements, and muscle tone remains normal.

Impulses from motor neurons in the spinal cord provide automatic movements, such as sudden flexion when exposed to a painful stimulus. The overlying sections have a regulatory effect on the motor cells of the spinal cord, and it can be both inhibitory and stimulating.

The brainstem nuclei are responsible for maintaining posture and balance. The vestibular nucleus increases the tone of the muscles that extend the limbs. The red core, on the contrary, bends the limbs. In this case, spinal motor neurons of opposite muscle groups are inhibited. This relationship is called reciprocal.

The cerebral cortex regulates voluntary human movements. To date, scientists have compiled detailed maps of the localization of areas that are responsible for the movement of individual parts of the body.

The motor cortex of the brain has an inhibitory effect on spinal motor neurons, which ensures holistic movements rather than individual muscle twitches. In a patient after a stroke, damaged areas of the cerebral cortex lose their inhibitory effect on underlying structures. Externally, this is manifested by the development of muscle hypertonicity.

Treatment

Increased skeletal muscle tone often becomes a serious obstacle to the recovery of patients after a stroke.

It should be borne in mind that the optimal result can only be obtained with a combination of drug and non-drug treatment methods.

Non-drug treatment of hypertension includes:

correct positioning of the patient;
massotherapy;
gymnastics;
physiotherapeutic procedures.

An integrated approach will help overcome spasticity and restore motor functions of the limbs

Among the medications, muscle relaxants and botulinum toxin are actively used.

Patient position

One of the main points in the treatment of muscle hypertonicity in patients after a stroke is giving the paretic limb a physiological position.

An effective way to combat spasticity

The affected hand should be placed on a chair next to the patient's bed. Due to increased muscle tone, it will be drawn towards the body. To prevent this phenomenon, a soft tissue roller is placed in the armpit.

The arm is extended at the elbow joint and turned palm up. Sandbags or other devices are used to hold the limb in this position. It is advisable to bandage the fingers and hand to a splint.

The leg should be slightly bent at the knee, and the foot should be at a right angle to the shin.

The duration of positioning treatment is about 2 hours. It can be repeated several times during the day. As soon as the attending physician allows, the patient is helped to sit down and taught to walk.

Massage

Massage relieves increased muscle tone well. It must be carried out from the first days of the disease. From massage techniques, you need to choose stroking and light rubbing. They help reduce muscle tone, improve blood circulation and lymph flow in the paretic limb. The duration of the first sessions should not exceed 10 minutes. Over time, it is increased to 20 minutes. The duration of the course depends on the individual characteristics of the patient and is determined by the attending physician. As a rule, after 20–30 sessions a break of 10–15 days is necessary. After this, the course is repeated. The decision to discontinue massage treatment depends on the results achieved.

Physiotherapy

The complex of therapeutic exercises consists of active and passive movements. Passive movements consist of flexion and extension of muscles, which is carried out by caring staff. If possible, the patient makes passive movements using a healthy limb. Due to increased tone, movements may initially be intermittent and abrupt. Over time, the tone decreases and they become smoother.

Exercise is very important for developing muscles and joints

As soon as a patient after a stroke is able to perform active movements, he should engage in therapeutic exercises independently. In addition to flexion and extension exercises, exercises aimed at stretching muscles are added. When performed correctly, they relieve hypertension well and help the patient recover faster.

If the patient has increased muscle tone after a stroke, exercises with expanders, elastic bands, and the like are strictly not recommended - they only intensify spastic phenomena and worsen the situation.

Muscle relaxants

Among the medications used to treat hypertension in patients after a stroke, centrally acting muscle relaxants are used, which effectively relieve muscle tone without affecting their strength. The mechanism of their action is to inhibit pathological impulses that come from spinal motor neurons.

Treatment with muscle relaxants begins with minimal doses. If necessary, they are increased to achieve effect. Expected effects:

decreased muscle tone;
improvement of motor functions;
pain relief;
prevention of contracture development;
increasing the effectiveness of therapeutic exercises;
facilitating patient care.

In our country, the most common muscle relaxants are baclofen, tizanidine, or sirdalud, tolperisone, or mydocalm, diazepam.

Doctors also prescribe muscle relaxants to restore and relax muscles.

The disadvantage of treatment with muscle relaxants is the possibility of developing side effects, of which the most common are:

drowsiness;
dizziness;
nausea;
constipation;
decrease in blood pressure.

Treatment with botulinum toxin

The use of botulinum toxin for the treatment of hypertonicity is indicated for post-stroke patients with local spasticity.

Main indications for the use of botulinum toxin:

absence of contractures;
severe pain syndrome;
impaired motor function associated with increased muscle tone.

The mechanism of action is to block the transmission of impulses from a nerve cell to a muscle fiber. The clinical effect develops a few days after the injection and lasts for 2–6 months, depending on the individual characteristics of the patient. Due to the production of antibodies, repeated injections do not eliminate hypertension as effectively.

This method is not widely used in the fight against hypertension in patients after a stroke. This is primarily due to the high cost of the drug.

Finally

Treatment of increased muscle tone in patients after a stroke is one of the key points, which will not only significantly improve the patient’s condition, but also make it easier to care for him.

Therapeutic exercise and massage are the main treatment areas, while monotherapy with muscle relaxants will not bring the expected result.

Medicines only enhance the effect of gymnastic procedures. Relatives or guardians caring for the patient need to remember this.

Parfenov V.A.
Moscow Medical Academy named after. THEM. Sechenov

Relevance of the problem

In Russia, 300-400 thousand strokes are registered annually, which leads to the presence of more than one million patients who have suffered a stroke. More than half of them remain with motor impairments, as a result of which the quality of life is significantly reduced and permanent disability often develops (1).

Motor disorders after a stroke most often manifest as hemiparesis or monoparesis of the limb with increased muscle tone of the type of spasticity (1,2,9). In stroke patients, spasticity usually increases in paretic limbs over several weeks and months; relatively rarely (most often when motor functions are restored), a spontaneous decrease in spasticity is observed. In many cases, in stroke patients, spasticity impairs motor functions, promotes the development of contracture and deformation of the limb, makes it difficult to care for an immobilized patient, and is sometimes accompanied by painful muscle spasms (2,5,6,9,14).

Restoration of lost motor functions is maximum within two to three months from the moment of stroke, after which the rate of recovery decreases significantly. One year after the onset of stroke, it is unlikely that the degree of paresis will decrease, but it is possible to improve motor functions and reduce disability by training balance and walking, using special devices for movement and reducing spasticity in paretic limbs (1,2,6,9,14)

The main goal of treating post-stroke spasticity is to improve the functionality of paretic limbs, walking, and self-care of patients. Unfortunately, in a significant proportion of cases, treatment options for spasticity are limited to reducing pain and discomfort associated with high muscle tone, facilitating the care of a paralyzed patient, or eliminating the existing cosmetic defect caused by spasticity (2,6,14).

One of the most important questions that has to be addressed when managing a patient with post-stroke spasticity comes down to the following: does spasticity worsen the patient’s functional capabilities or not? In general, the functional capabilities of the limb in a patient with post-stroke paresis of the limb are worse in the presence of severe spasticity than in its mild degree. At the same time, in some patients with a severe degree of paresis, spasticity in the leg muscles can make standing and walking easier, and its decrease can lead to a deterioration in motor function and even falls (2,6,14).

Before starting to treat post-stroke spasticity, it is necessary to determine the treatment options for a particular patient (improving motor functions, reducing painful spasms, facilitating patient care, etc.) and discuss them with the patient and (or) his relatives. Treatment options are largely determined by the time since the disease and the degree of paresis, the presence of cognitive disorders (2,6,14). The shorter the time since the onset of the stroke that caused spastic paresis, the more likely it is that treatment of spasticity will improve, because it can lead to a significant improvement in motor functions, preventing the formation of contractures and increasing the effectiveness of rehabilitation during the period of maximum plasticity of the central nervous system. With a long duration of the disease, a significant improvement in motor functions is less likely, but it is possible to significantly facilitate patient care and relieve the discomfort caused by spasticity. The lower the degree of paresis in a limb, the more likely it is that treating spasticity will improve motor function (14).

Physiotherapy

Therapeutic gymnastics is the most effective direction for managing a patient with post-stroke spastic hemiparesis; it is aimed at training movements in paretic limbs and preventing contractures (2,14).

Physiotherapy methods include positioning treatment, teaching patients to stand, sit, walk (with the help of additional means and independently), bandaging the limb, using orthopedic devices, thermal effects on spastic muscles, as well as electrical stimulation of certain muscle groups, such as extensors of the fingers or tibialis anterior muscle (4).

Patients with severe spasticity in the flexors of the upper extremities should not be recommended intensive exercises that can significantly increase muscle tone, for example, squeezing a rubber ring or ball, or using an expander to develop flexion movements in the elbow joint.

Massage of the muscles of paretic limbs, which have high muscle tone, is possible only in the form of light stroking; on the contrary, in antagonist muscles, you can use rubbing and shallow kneading at a faster pace.

Acupuncture is relatively often used in our country in the complex therapy of patients with post-stroke spastic hemiparesis, however, controlled studies conducted abroad do not show significant effectiveness of this treatment method (10).

Muscle relaxants

Baclofen and tizanidine are predominantly used in clinical practice as oral medications for the treatment of post-stroke spasticity (5-7). Antispastic agents used internally, by reducing muscle tone, can improve motor functions, facilitate care for an immobilized patient, relieve painful muscle spasms, enhance the effect of physical therapy and, as a result, prevent the development of contractures. For mild spasticity, the use of muscle relaxants can lead to a significant positive effect, but for severe spasticity, large doses of muscle relaxants may be required, the use of which often causes undesirable side effects (2.5-7.14). Treatment with muscle relaxants begins with a minimum dose, then it is slowly increased to achieve effect. Antispastic agents are usually not combined.

Baclofen (Baklosan) has an antispastic effect mainly at the spinal level.

The drug is an analogue of gamma-aminobutyric acid (GABA); it binds to presynaptic GABA receptors, leading to a decrease in the release of excitatory amino acids (glutamate, aspartate) and suppression of mono- and polysynaptic activity at the spinal level, which causes a decrease in spasticity.

Over its long history, it remains the drug of choice in the treatment of spasticity of spinal and cerebral origin.

Baclofen also has a central analgesic effect and has an anti-anxiety effect. It is well absorbed from the gastrointestinal tract, the maximum concentration in the blood is reached 2-3 hours after administration. Baclofen (baclosan) is used for spinal (spinal injury, multiple sclerosis) and cerebral spasticity; it is effective for painful muscle spasms of various origins. Baclofen (Baklosan) The initial dose is 5-15 mg per day (in one or three doses), then the dose is increased by 5 mg every day until the desired effect is obtained, the drug is taken with meals. The maximum dose of baclofen (baclosan) for adults is 60-75 mg per day. Side effects include drowsiness and dizziness at the beginning of treatment, although they are clearly dose-dependent and may subsequently subside. Sometimes nausea, constipation, diarrhea, and arterial hypotension occur.

Baclofen can be used intrathecally using a special pump for spasticity caused by various neurological diseases, including the consequences of stroke (8,11,13). The use of a baclofen pump in combination with therapeutic exercises and physiotherapy can improve the speed and quality of walking in patients with post-stroke spasticity who are capable of independent movement (8). The existing 15-year clinical experience of using baclofen intrathecally in patients who have suffered a stroke indicates the high effectiveness of this method in reducing not only the degree of spasticity, but also pain syndromes and dystonic disorders (13). A positive effect of a baclofen pump on the quality of life of stroke patients has been noted (11). Tizanidine is a centrally acting muscle relaxant, an alpha-2 adrenergic receptor agonist. The drug reduces spasticity due to suppression of polysynaptic reflexes at the level of the spinal cord, which can be caused by inhibition of the release of excitatory amino acids and activation of glycine, which reduces the excitability of spinal cord interneurons. The drug also has a moderate central analgesic effect and is effective for cerebral and spinal spasticity, as well as for painful muscle spasms. The initial dose of the drug is 2-6 mg per day in one or three doses, the average therapeutic dose is 12-24 mg per day, the maximum dose is 36 mg per day. Side effects may include severe drowsiness, dry mouth, dizziness and a slight decrease in blood pressure.

Botulinum toxin

In patients who have had a stroke and have local spasticity in paretic muscles, botulinum toxin type A or botulinum toxin (Botox, Dysport) can be used. The use of botulinum toxin is indicated if a patient who has suffered a stroke has a muscle with increased tone without contracture, and also has pain, muscle spasms, decreased range of motion and impaired motor function associated with spasticity of this muscle (2-4,12,14) . The effect of botulinum toxin when administered intramuscularly is caused by blocking neuromuscular transmission due to suppression of the release of the neurotransmitter acetylcholine into the synaptic cleft.

The clinical effect after injection of botulinum toxin is observed after a few days and lasts for 2-6 months, after which a second injection may be required. The best results are observed when using botulinum toxin in the early stages (up to a year) from the moment of illness and mild paresis of the limb. The use of botulinum toxin may be particularly effective in cases where there is equinovarus deformity of the foot caused by spasticity of the posterior leg muscles, or high tone of the flexor muscles of the wrist and fingers, which impairs the motor function of the paretic hand (14). Controlled studies have demonstrated the effectiveness of Dysport in the treatment of post-stroke spasticity in the arm (3).

Side effects from using botulinum toxin may include skin changes and pain at the injection site. They usually regress on their own within a few days after the injection. Significant weakness of the muscle into which botulinum toxin is injected is possible, as well as weakness in the muscles located close to the injection site, and local autonomic dysfunction. However, muscle weakness is usually compensated by the activity of agonists and does not lead to a weakening of motor function. Repeated injections of botulinum toxin in some patients give a less significant effect, which is associated with the formation of antibodies to botulinum toxin and blocking its action. The limited use of botulinum toxin in clinical practice is largely due to its high cost.

Surgical methods of treatment

Surgeries to reduce spasticity are possible at four levels - the brain, spinal cord, peripheral nerves and muscles (2,14). They are rarely used in patients with post-stroke spasticity. These methods are more often used for cerebral palsy and spinal spasticity caused by spinal injury.

Brain surgeries include electrocoagulation of the globus pallidus, ventrolateral nucleus of the thalamus, or cerebellum and implantation of a stimulator on the surface of the cerebellum. These operations are rarely used and have a certain risk of complications.

A longitudinal dissection of the conus (longitudinal myelotomy) can be performed on the spinal cord to sever the reflex arc between the anterior and posterior horns of the spinal cord. The operation is used for spasticity of the lower extremities; it is technically complex and associated with a high risk of complications, so it is rarely used. Cervical posterior rhizotomy can lead to a reduction in spasticity not only in the upper extremities, but also in the lower extremities, but is rarely performed due to the risk of complications. Selective posterior rhizotomy is the most common procedure performed on the spinal cord and its roots and is usually used for spasticity in the lower extremities from the second lumbar to the second sacral root.

Dissection of peripheral nerves can eliminate spasticity, but this operation is often complicated by the development of pain, dysesthesia and often requires additional orthopedic surgery, so it is rarely used.

A significant part of surgical operations in patients with spasticity of various origins is performed on muscles or their tendons. Lengthening the muscle tendon or relocating the muscle reduces the activity of intrafusal muscle fibers, thereby reducing spasticity. The effect of the operation is difficult to predict; sometimes several operations are required. When contracture develops, surgical intervention on the muscles or their tendons is often the only method of treating spasticity.

Conclusion

Treatment of post-stroke spasticity is an urgent problem in modern neurology. The leading role in the treatment of post-stroke spasticity is played by therapeutic exercises, which should begin from the first days of stroke development and be aimed at training lost movements, independent standing and walking, as well as preventing the development of contractures in paretic limbs.

In cases where a patient with post-stroke paresis of a limb has local spasticity that causes deterioration in motor functions, local administration of botulinum toxin preparations can be used.

Recommended as medicinal antispastic agents for oral use. Baclofen (Baklosan) and tizanidine, which can reduce increased tone, facilitate physiotherapeutic exercises, as well as caring for a paralyzed patient. One of the promising methods for treating post-stroke spasticity is intrathecal administration of baclofen using a special pump, the effectiveness of which has been actively studied in recent years.

LITERATURE
1. Damulin I.V., Parfenov V.A., Skoromets A.A., Yakhno N.N. Circulatory disorders in the brain and spinal cord. In the book: Diseases of the nervous system. Guide for doctors. Ed. N.N. Yakhno. M.: Medicine, 2005, T.1., pp. 232-303.
2. Parfenov V.A.. Spasticity In the book: The use of Botox (botulism toxin type A) in clinical practice: a guide for doctors / Ed. O.R. Orlova, N.N. Yakhno. – M.: Catalog, 2001 – P. 91-122.
3. Bakheit A.M., Thilmann A.F., Ward A.B. et al. A randomized, double-blind, placebo-controlled, dose-ranging study to compare the efficacy and safety of three doses of botulinum toxin type A (Dysport) with placebo in upper limb spasticity after stroke // Stroke. – 2000. – Vol. 31. – P. 2402-2406.
4. Bayram S., Sivrioglu K., Karli N. Et al. Low-dose botulinum toxin with short-term electrical stimulation in poststroke spastic drop foot: a preliminary study // Am J Phys Med Rehabil. – 2006. - Vol. 85. – P. 75-81.
5. Chou R., Peterson K., Helfand M. Comparative efficacy and safety of skeletal muscle relaxants for spasticity and musculoskeletal conditions: a systematic review. // J Pain Symptom Manage. – 2004. – Vol. 28. – P.140–175.
6. Gallichio J.E. Pharmacologic management of spasticity following stroke. // Phys Ther 2004. – Vol. 84. – P. 973–981.
7. Gelber D. A., Good D. C., Dromerick A. et al. Open-Label Dose-Titration Safety and Efficacy Study of Tizanidine Hydrochloride in the Treatment of Spasticity Associated With Chronic Stroke // Stroke. – 2001. - Vol.32. – P. 1841-1846.
8. Francisco G.F., Boake C. Improvement in walking speed in poststroke spastic hemiplegia after intrathecal baclofen therapy: a preliminary study // Arch Phys Med Rehabil. – 2003. – Vol. 84. – P. 1194-1199.
9. Formisano R., Pantano P., Buzzi M.G. et al. Late motor recovery is influenced by muscle tone changes after stroke // Arch Phys Med Rehabil. – 2005. – Vol. 86. – P.308-311.
10. Fink M., Rollnik J.D., Bijak M. Et al. Needle acupuncture in chronic poststroke leg spasticity // Arch Phys Med Rehabil. - 2004. – Vol. 85. – P.667-672.
11. Ivanhoe C.B., Francisco G.E., McGuire J.R. et al. Intrathecal baclofen management of poststroke spastic hypertonia: implications for function and quality of life // Arch Phys Med Rehabil. – 2006. – Vol. 87. – P. 1509-1515.
12. Ozcakir S., Sivrioglu K. Botulinum toxin in poststroke spasticity // Clin Med Res. – 2007. – Vol. 5. – P.132-138.
13. Taira T., Hori T. Intrathecal baclofen in the treatment of post-stroke central pain, dystonia, and persistent vegetative state // Acta Neurochir Suppl. – 2007. – Vol.97. – P. 227-229.
14. Ward A.B. A summary of spasticity management – a treatment algorithm // Eur. J. Neurol. – 2002. – Vol. 9. – Suppl.1. – P. 48-52.

A sedentary lifestyle and excessive exercise lead to stroke. The person experiences poor activity in the arms, hands, legs, and fine motor skills of the fingers.

Why this happens: due to lack of physical movement, blood circulates worse, preventing the brain from receiving the necessary energy. In the second case, there is a large release of adrenaline into the blood, which accelerates the work of the heart, enhances, and then disrupts blood circulation in the brain.

Restorative set of exercises for hands

Restoring the original movements will take a long time. Due to illness, a person may not feel his paralyzed parts of the body, and sometimes deny the presence of motor disorders, which can be encountered with low mental activity.

When performing exercises, you must:

Before starting the workout, you need to stretch the fingers of your paralyzed hand for about 15–20 seconds.
Place the affected hand on the patient’s chest and ask him to lift each finger one by one. First, the exercise should be performed with the palm facing down, and only then with the arm straightened.
In exactly the same positions as in previous classes, turn your fingers clockwise and counterclockwise. It is difficult to perform such gymnastics on your own, so a person who has suffered a stroke needs help.

Squeeze the patient’s hand after a stroke into a fist and then completely straighten the palm and spread the fingers.
Close your left and right hands into a lock. In this position of the hands, alternately raise and lower your fingers.
Alternately performing finger snaps on the paralyzed limb.
To warm up fine motor skills, use a bubble massage ball.

To start moving the phalanges better, develop them using a children's toy cube - a Rubik's cube. This way the victim will quickly learn to properly control the grip force.

Initial rehabilitation period

To make it easier for the patient to restore movement of the joints of the hand, he needs support. The warm-up at first should be aimed at restoring large extensor and flexor muscles, and then warm up fine motor skills of the hands with the help of ergotherapy.

In the exercises, it is important that the joints take part, starting from the easiest ones, with a gradual transition to more complex exercises. If the exercises are difficult, suggest closing your eyes and mentally imagining that the paralyzed hand and forearm are working like a healthy limb.

If fine motor development is slow, praise the patient even for very little progress during recovery.

You shouldn’t do all the difficult exercises for the patient; let him also try, at least for relief, to help himself with his healthy hand. It is worth considering that after a stroke, recovery of arm movements always takes longer; it will be much easier to rehabilitate a paralyzed leg.

If in-patient rehabilitation after a stroke takes place under the supervision of experienced specialists, then upon discharge the patient is monitored by close people. It will depend only on them whether the victim will be able to independently stand on his paralyzed leg or make movements with his hand or arm.

Rehabilitation is also important for returning normal speech, memory and thinking. Blood pressure and cholesterol play an important role in recovery.

The main problem will come from the presence of spasticity in the arm and leg, which can be solved with the help of activities aimed at the following:

Reduced spasticity.
Reducing feelings of paralysis.
Increasing the mobility of the arm and leg joints after a stroke.
Improved nutrition in tissues.

It is the spasticity that appears that prevents any motor activity. This occurs as a result of prolonged immobility after a stroke.

To normalize tone and reduce spasticity during recovery, the attending physician may advise the victim’s relatives the following:

Constantly change the position of the injured arm and leg.
Place a soft ottoman under the leg on the spastic side at the level of the joint.
At first, it is better to practice under the supervision of others.
Before starting exercises, perform a warm-up aimed at stretching paralyzed muscles.
Monitor the temperature in the room with particular care. Cold can cause increased sensations of spasticity.
Warm up your hands during the massage, then begin the procedure. The movements of the massage therapist's hands should be soft and of low intensity.

Speed of rehabilitation

To restore basic movements after a stroke, each patient needs to follow an individual program.

How long this will take will depend on the following factors:

During which stroke the leg or arm was paralyzed.
How severely the brain tissue was damaged.
Did the patient receive medical treatment himself or with someone’s help and how quickly did this happen?
What methods and medications were used during the rehabilitation period of the victim.
Did the patient take part in a conversation with a psychologist? How productive were the sessions with the speech therapist and relatives? Did this help improve your emotional state?

If the brain is not seriously damaged, recovery may take from 7 to 20 days. Under the worst circumstances, from six months to several years. One week or 2-3 months is enough to develop speech abilities. To restore fine motor movements of the fingers, the hand must be trained for at least 4 weeks. From one month to learn to lean on a paralyzed leg.

When the main rehabilitation process is completed, but the patient after a stroke does not perform some movements quite correctly, you can help if you involve him in simple home hobbies. For example, get interested in beadwork, playing chess, checkers or cross-stitching.

If you have a computer at home, let him practice typing on the keyboard. But especially important for restoring fine motor skills will be children's games such as construction sets with details: mosaics, pyramids or puzzles.

Try asking the victim to lift small objects from the floor. A positive effect can be achieved by asking to collect scattered small buttons, beads or small coins from the table.

You should not limit the victim from playing sports, just monitor the intensity of the exercises performed. Crafts made from colored paper or figurines will have a positive effect on restoring the mobility of small joints of the hand. Nordic walking, light morning jogging without obstacles, and cycling are considered useful sports for stroke patients.

Spasticity. Part 1.

Previously this word was unfamiliar to me. Spasticity resembles stiffness in very, very cold hands, when you want to move your fingers, but you can’t. Plus, it also brings them together and distorts them.

When my recovery from the stroke began, this condition was virtually throughout my entire body. Especially strong on the left side. I was almost completely paralyzed, but I still could not make much movement. They turned out as if in condensed milk. Tight, clumsy and very slow. There was constant tension in my hands and fingers. It did not go away for a minute, even in a calm state, and did not allow normal movements. The hands involuntarily took an unnatural position. The left one was retracted away from the body. The right one bent at the elbow and pulled up to the chest. I was very tired physically and mentally because I couldn’t relax. Only in a lying position it was easier. But as soon as I sat down, the muscles of the body and limbs tensed like crazy. From excessive tension I quickly got tired again. It was possible to sit for one or two minutes and the strength ran out.

Spasticity made it impossible to make subtle and precise movements. For example, if they handed me a cup of water, I couldn’t take it. If he didn’t “hit” it, he missed. When they put the cup in my hand, I could not hold it and wrap my fingers around it. They didn't shrink. At the same time, the tension in my hand was unreal. All this rigmarole was wildly exhausting. Relieving spasticity in all limbs at once is not a realistic task. It's too big. And we, as always, broke the difficult task into simple fragments that became feasible. We decided to divide the treatment of spasticity into pieces:

It has become easier. During the training, I noticed that the decrease in spasticity in my left hand was accompanied by little relief in my right hand and legs. The connection is not significant, but noticeable. We did exercises and massages evenly for both left and right limbs. Although the spasticity was much stronger on the left side of the body. Over time, everything became equal. This approach turned out to be correct.

It was possible to relieve spasticity with a combination of gymnastics and massages.

Start with minimal movements.

Do not exert heavy loads during exercise.

Do the minimum number of repetitions.

Do not do active and strong massage. Light touches only.

Do not add or increase muscle tone.

Learn to relax your muscles and relieve tension in them.

Do not do gymnastics to relieve spasticity when you are tired.

Exercise only in the morning.

While recovering from a stroke, I got used to the fact that there are no simple tasks. But removing spasticity turned out to be extremely difficult work. The point is the contradiction of the tasks being performed. After the stroke, I needed to restore muscle strength throughout my body. That is, to work hard and hard. But at the same time, spasticity must be treated. And for this, loads and endurance training are a hindrance. It turns out that the first excludes the second. We solved this puzzle by alternating classes. One day: massage + gymnastics to relieve spasticity + exercises to restore balance and coordination. This does not require much strength, the load is not great. The next day: strength + endurance exercises. And so on in turn.

At this point, the spasticity was removed. There are some leftovers, but they don't interfere. Freedom and lightness returned to my movements. The tension is gone. Muscle pain and fatigue are gone. I began to spend less energy on movements. This made it possible to gradually increase the load on morning exercises.

In order for recovery after a stroke to give good results, you have to follow this regimen. Gradually I am gaining strength and increasing my endurance. Now I can conduct classes in one day. In the morning I do exercises with strength exercises. In the afternoon, gymnastics and massages to relieve spasticity + exercises for balance and coordination. Half a day between classes is enough for rest.

Treatment of spasticity after stroke

Stroke is one of the most pressing problems of modern medicine. High percentage of mortality and loss of performance, tendency to form

persistent residual effects, frequent damage to patients of working age are the main points that explain the need to develop effective preventive and treatment measures.

Development mechanism

To better understand the mechanism of development of muscle hypertonicity, let's consider the main aspects of movement regulation.

The earlier classes to prevent spasticity begin, the better the result.

Normally, muscle contractions are regulated at three levels:

spinal cord;
stem nuclei of the brain;
cortex.

Any of these sections can stimulate muscle contraction. Thanks to the close cooperation of these departments, a person can perform the necessary movements, and muscle tone remains normal.

The cerebral cortex regulates voluntary human movements. To date, scientists have compiled detailed maps of the localization of areas that are responsible for the movement of individual parts of the body.

Treatment

Increased skeletal muscle tone often becomes a serious obstacle to the recovery of patients after a stroke.

It should be borne in mind that the optimal result can only be obtained with a combination of drug and non-drug treatment methods.

Non-drug treatment of hypertension includes:

correct positioning of the patient;
massotherapy;
gymnastics;
physiotherapeutic procedures.

An integrated approach will help overcome spasticity and restore motor functions of the limbs

Among the medications, muscle relaxants and botulinum toxin are actively used.

Patient position

One of the main points in the treatment of muscle hypertonicity in patients after a stroke is giving the paretic limb a physiological position.

An effective way to combat spasticity

The arm is extended at the elbow joint and turned palm up. Sandbags or other devices are used to hold the limb in this position. It is advisable to bandage the fingers and hand to a splint.

The leg should be slightly bent at the knee, and the foot should be at a right angle to the shin.

Massage

Physiotherapy

Exercise is very important for developing muscles and joints

Muscle relaxants

Treatment with muscle relaxants begins with minimal doses. If necessary, they are increased to achieve effect. Expected effects:

decreased muscle tone;
improvement of motor functions;
pain relief;
prevention of contracture development;
increasing the effectiveness of therapeutic exercises;
facilitating patient care.

In our country, the most common muscle relaxants are baclofen, tizanidine, or sirdalud, tolperisone, or mydocalm, diazepam.

Doctors also prescribe muscle relaxants to restore and relax muscles.

The disadvantage of treatment with muscle relaxants is the possibility of developing side effects, of which the most common are:

drowsiness;
dizziness;
nausea;
constipation;
decrease in blood pressure.

Treatment with botulinum toxin

The use of botulinum toxin for the treatment of hypertonicity is indicated for post-stroke patients with local spasticity.

Main indications for the use of botulinum toxin:

absence of contractures;
severe pain syndrome;
impaired motor function associated with increased muscle tone.

This method is not widely used in the fight against hypertension in patients after a stroke. This is primarily due to the high cost of the drug.

Finally

Treatment of increased muscle tone in patients after a stroke is one of the key points, which will not only significantly improve the patient’s condition, but also make it easier to care for him.

Therapeutic exercise and massage are the main treatment areas, while monotherapy with muscle relaxants will not bring the expected result.

Medicines only enhance the effect of gymnastic procedures. Relatives or guardians caring for the patient need to remember this.

Post-stroke spasticity

Until now, we have hardly discussed movement disorders in our loved ones, since there is no direct connection with cognitive disorders, and we did not want to dilute the main theme of our site. However, recent discussion of the problems that develop after a stroke - and in Russia stroke remains a very common cause of dementia - has shown that this topic is important.
I was asked to talk about it without much fuss, in simple words. I promised to try.

I read in a serious scientific journal that after a stroke, movement disorders manifest themselves in one way or another in more than 80% of patients. Due to the death of cells that previously regulated muscle function, they weaken (paresis) or turn off completely (paralysis). Disorders of body position and coordination of movements are also possible. This is fraught with falls and, at best, a developing fear of walking independently, and at worst, a fracture. The “head problems” that appear along with this only increase the risks.

Fortunately, even in old age, the plasticity of the brain allows it to restructure itself and gradually restore lost motor functions. And here the task of doctors (and, after overcoming an acute disorder, of those around them) is to create the necessary conditions for speedy rehabilitation: the main method is physical therapy in combination with physical and occupational therapy.

However, in approximately every third case, in the post-stroke period, so-called spasticity begins to develop - increased tone in the muscle, preventing it from stretching and forcibly returning the limb to a certain position, which limits overall mobility. The spasm is quite difficult to respond to physiotherapy and interferes with normal recovery. As it turned out, visitors to our site also encountered this phenomenon.

Due to constant tone, which does not decrease even at rest, changes begin to occur in muscles, tendons and joints (fibrosis, atrophy), painful deformations (contractures) and pathological postures develop, which aggravate the problem and seriously complicate the patient’s life.

Spasticity does not develop immediately, usually several months after a stroke. However, a specialist may notice the first signals after 2–3 weeks. Initially, flabby muscles come into tone, which increases and becomes more pronounced in response to external stimuli (for example, an attempt to bend or straighten a limb). After six months, maximum a year, spasticity turns into a problem that significantly affects the patient’s quality of life. It's getting painful.

In the upper body, the shoulder, elbow, wrist and fingers are often affected. In the lower body, spasticity may affect the hip, knee, ankle, or toes. The flexor muscles in the arm area are usually affected, and the extensors in the leg.
Look at the pictures from our newspaper “Memini”.

You've probably seen something similar in patients with cerebral palsy.
Needless to say, this problem has a negative impact on a person’s ability to dress independently, eat (he is simply unable to hold a spoon), write with a pen, hygiene suffers, etc.
If spasticity is not treated, then after 3–4 years contractures—deformations of the joints—form. Bones also become deformed. Forced painful postures arise.

I won’t write about who is to blame. I immediately turn to the question “What to do?”

The answer is simple: treat.

Treatments for spasticity may include:
prescription of medications (central and local action),
physiotherapy,
occupational therapy.
(In rare cases, surgery may be considered.)
The basis of therapy is the effect on the muscle, allowing it to decrease its tone. Below we will consider in more detail the role of each of these methods.

PURPOSE OF MEDICINES

Oral (taken by mouth) medications most commonly used to reduce spasticity include:

centrally acting muscle relaxants– baclofen, tizanidine, etc.

anticonvulsants– clonazepam, diazepam.

Both groups of drugs help reduce muscle contraction and improve range of motion. Taking them relieves painful muscle spasms, enhances the effect of physical therapy and, as a result, prevents the development of contractures. Unfortunately, the peculiarity of these drugs is that they act not only on spastic muscles, but on the entire body as a whole. To treat spasticity, these drugs are prescribed in large dosages, which leads to side effects such as general weakness, dizziness, changes in mood and lethargy. This is especially unpleasant if the patient, after a stroke, begins to develop cognitive impairment without it.

For this reason, more and more specialists are inclined to replace the above-mentioned medications with injections of botulinum toxin type A. In terms of the strength of its effect on the muscle, botulinum toxin is significantly superior to all existing medications taken in tablet form and is comparable to surgical intervention. At the same time, muscle denervation using a toxin is an extremely simple and safe procedure that can be performed by a doctor who has undergone appropriate training. Botulinum toxin preparations are well tolerated, and the likelihood of drug-drug interactions when used is minimal. The American Academy of Neurology's recommendation specifically calls for offering botulinum neurotoxin to patients as a method of reducing muscle tone and improving passive function in adult patients with spasticity.

In our country, three botulinum toxin preparations are widely used to treat spasticity: Botox (USA), Dysport (England), Xeomin (Germany). The latter is positioned by the manufacturer as a new generation drug, free from complexing proteins. In addition, the Chinese drug Lantox is registered in Russia, but, as far as I know, it is used mainly in cosmetology.

Physical therapy has traditionally played an important role in the treatment of spasticity. The main components of the method include rehabilitation exercises, massage, acupuncture, thermal and electrical effects on spastic muscles, and the use of orthopedic devices.

Standard rehabilitation involves daily stretching to help restore strength to affected muscles, maintain joint range of motion, and prevent the development of contractures. Regular stretching can ease muscle contraction and reduce stiffness for a period of several hours.

Massage plays an important role in the process of restoring motor functions and preventing pathological conditions. It relieves pain, helps restore muscle performance, and improves their blood supply. However, you can only trust a specialist to perform a massage, since spastic and hypotonic muscles require different influences.

In Russia, acupuncture is often used in complex therapy, but controlled studies conducted abroad do not show significant effectiveness of this treatment method.

Electrical stimulation is widely used to restore balance between the tone of flexor and extensor muscles. The effect usually lasts about 10 minutes when stimulation is first applied, but after several months of similar treatments, the effect may be longer lasting. Alternatively, a spastic muscle can also be stimulated directly to fatigue it.

In the treatment of spasticity, limb fixing bandages, bandages, tourniquets, splints, and orthoses can be used. They allow you to support and straighten a spastic limb, as well as correct its deformity and improve function. Today, medical engineering has developed many orthopedic devices that provide not only immobilization and fixation in the correct position, but also deep pressure and maintenance of heat in the tissues. Modern devices include a setting mechanism that controls the required function: from fixation with a lock to providing the necessary movements with outside help.

OCCUPATIONAL THERAPY OR OCCUPATIONAL THERAPY

Occupational therapy is practical activities specially selected by a doctor that allow the patient to restore self-care skills after a stroke. This can be considered a special version of physical therapy, in which the exercise performed has a practical meaning: fastening a button, using cutlery... With the help of occupational therapy - by regularly repeating the same movements - patients restore lost skills of daily life, whenever possible. Otherwise, when it is not possible to restore some important actions, occupational therapy allows you to choose devices that compensate for the loss of a useful skill, or to form new motor patterns, alternative to those used before the disease.

In other words, functional therapy aims to preserve all functions of the limb by restoring old motor patterns and/or creating new dynamic patterns based on a new muscle arrangement that allows normal movement. An important role here is played not only by the diligence of the patient, but also by the help of the person caring for him.

The two main categories of surgical interventions used for spasticity are performed at the level of the nervous system (neurosurgery) or bones, tendons and muscles (orthopedic surgery). The most significant indication for surgical treatment is the development of contracture. In this case, orthopedic surgery is often the only treatment for spasticity. With the help of surgery, muscles can be denervated, tendons and muscles can be released from contractures, lengthened or repositioned, thereby reducing spasticity. Muscles can be denervated by cutting off specific nerves where they exit the spinal cord (dorsal rhizotomy). This surgery is used primarily to treat severe spasticity in the leg muscles that interferes with the patient's mobility.

To briefly summarize, the ideal option is to relax with botulinum toxin (lasts about 3-4 months) and develop. That's just the prices.

Although I read two studies. In one, the authors argued that if you count the costs that can be avoided thanks to botulinum therapy (nurses, aids), then overall it turns out to be even beneficial. In another scientific language it is said approximately the following: it is better to spend money and get results than to take pills in large doses (in our country, by the way, they are also not free), without much success.
True, both studies were conducted abroad.

Hand spasticity after stroke

Mom has a stroke. Treatment and rehabilitation after stroke.

2556. Ilya | 30.11.2013, 18:40:34

Listen, please, everyone!

I myself am an instructor in restoring movements using wave techniques, and the author of the insult5.ru project.

2557. Ilya | 30.11.2013, 18:40:50

In addition, the muscles on the affected side are weak, atrophied, and it is basically impossible to strengthen them with pills, injections, or massagers.

We have a technique, a training video, and results for a 68-year-old man, after a terrible hemorrhagic stroke and paralysis, after 5 months. classes, the abs pump, and he walks with light support.

Our other student (54 years old, with craniotomy, movement coordination disorder, barely able to move, with severe spasticity of the arm and paralysis of the leg) after 3 weeks of classes began to stand up on his own without support and stand upright (classes continue)

Another client (72 years old, ischemic stroke 3 years ago, lack of any rehabilitation, contracture + paralysis of the left arm) during the 2nd lesson was able to move it to a bend, 10 cm, and lift it by 5 cm.

So, dear forum users! From my own experience, I want to say (I can no longer remain silent, reading some comments) MOVEMENT DISORDER IS TREATED MAINLY BY CORRECTLY ORGANIZED, GENTLE MOVEMENT, A COMBINATION OF DYNAMIC AND WAVE LOAD. (And the fact that they grumble and sometimes irritate them with their behavior - they are like children, they do not need pity, and not punishment in the form of: “Oh, you are so! I won’t come!” THEY ONLY NEED HELP IN RESTORING MOTOR SKILLS, THE REST THEY WILL DO IT THEMSELVES: go to the toilet, shave, eat, etc.

I don't want to be unfounded. And I suggest that those who really need help here, and not “just complain,” take a course to restore movements at home. Go here: insult5.ru. I myself will guide you, advise you, and send you the necessary exercises. And you will post here on the forum about the results. This will help you and give hope to many other people. I can help those in Moscow personally.

Articles

Exercises to restore movement in the hand

There are many literary sources and publications that describe exercises aimed at restoring hand function. However, the bulk of the recommendations are suitable for people whose motor functions have not been completely lost.

We will try to describe recovery process. starting with a complete lack of movement in the affected arm.

Hand exercises need to start right away after paralysis. At the first stage, the main tasks of rehabilitation of the upper limb are:

1. Prevention of joint stiffness in the affected limb by performing passive movements in all joints of the paralyzed arm. Passive movements should be performed repeatedly throughout the day.

2. Slowing down the process of muscle atrophy: if there are no contraindications, then massage and electrical myostimulation are performed.

3. Prevention of injuries and sprains of the joint capsule of the shoulder joint: when the patient takes a vertical position, the sore arm should be placed in a shoulder scarf and fixed to the body.

1. Flexion - extension of the arm at the elbow.

2. The arm is bent at the elbow, straightening the arm upward.

3. The arm is bent at the elbow, the shoulder is moved to the side, the arm is straightened upward.

6. Flexion - extension in the wrist joint.

7. Squeezing - unclenching fingers.

8. Adduction - abduction and opposition of the thumb.

All exercises are performed passively (with outside help). The number of repetitions in each exercise is at least 50 times.

As active movements appear in the paralyzed arm, they begin to add to the set of exercises active-passive exercises. which are performed with outside help or with the help of a healthy limb.

When active movements occur in the affected limb, special attention should be paid correctness of the restored movements.

As a rule, people, not knowing the intricacies of the recovery process, are happy about any movements that appear and begin to actively develop them - this is main mistake. because in most cases, the first movements that appear are incorrect. Consolidation of incorrect movements leads to the appearance of spasticity and the formation of spastic contractures and stiffness of the joints.

Examples of active-passive exercises in a supine position:

1. Bend your arms at the elbows.

2. Arms bent at the elbows in front of the chest, straightening the arms upward.

3. Raising straight arms up.

Exercises can be performed by keeping your fingers in the “lock” position or fixing the affected limb (with an elastic bandage) to a gymnastic stick.

As the patient recovers, exercises begin to be performed from a sitting and standing position, which allows for more amplitude movements.

Restoring hand and finger movements

The most labor-intensive process is restoration of fine motor skills.

Many patients who have suffered a stroke, traumatic brain injury, or brain surgery develop spastic flexion contractures of the hand and fingers. Before you begin to restore movement, you must remove pathological tone and develop contractures. Spasticity is relieved with the help of muscle relaxants, massage and physiotherapeutic procedures.

Development of contractures- the process is painful and traumatic: not every person is ready to endure significant pain. When the patient experiences pain, the tone in the affected arm increases, which is why pain occurs when the joints develop.

This vicious circle can be overcome by correctly calculated scheme of rehabilitation measures. which includes:

Deep warming of spastic muscle groups and stressed joints;

Electromyostimulation of antagonist muscles;

Passive development of movements in joints;

Staged fixation of the limb in extreme positions using individual splints.

Let's take a closer look at these procedures.

1. Massage can be performed with the addition of warming ointments. The main task of massage is to stimulate blood flow to the massaged area, to warm up and give elasticity to the ligaments that are planned to be developed.

2. Deep heating carried out using physiotherapeutic paraffin and ozokerite applications. Prolonged exposure to heat reduces spasticity and promotes muscle relaxation. Working out the joint after warming up is less painful.

3. Electromyostimulation of antagonist muscles- this is the stimulation of muscle groups opposite to the muscles in spasticity. Thus, a balance is gradually formed between these muscle groups.

4. Passive development of the joint- gradual stretching of the spasmed muscle, as well as contracted ligaments. With the help of repeatedly repeated passive movements, with a gradually increasing amplitude, the range of movements in the joint increases, the muscles and ligaments become more elastic.

5. After the development of the joint is completed, the hand and fingers must fix in extension position. to the maximum angle. Fixation can be achieved using orthoses for the wrist joint. as well as splints made from plaster or polymer bandages.

As the range of motion of the limb being developed increases, the splints must be changed.

This scheme for the development of spastic contractures allows quickly achieve stable results. while causing minimal pain to the patient.

Restoring hand and finger movements begins with active-passive exercises. After movements of all fingers and movements in the wrist joint have been restored, proceed to restoration of fine motor skills and individual finger movements: for example, learning to pick up and carry objects. The smaller the object, the more difficult it is to grasp and hold.

An approximate set of exercises aimed at restoration of basic movements in the elbow, hand and fingers(exercises are performed while sitting at a table):

1. Flexion - extension of the arm at the elbow along the table surface.

2. Bend the arm at the elbow towards the shoulder, without lifting the elbow from the table.

3. Sliding your hand back and forth across the table.

4. Circular movements of the hand along the surface of the table.

5. Turn the hand palm up.

6. The brush hangs from the table, lifting the brush.

7. Squeezing - unclenching the fingers, palm on the table surface.

8. Clenching and unclenching your fingers, palm up.

Spasticity or spasticity is a movement disorder caused by increased muscle tone.

In a normal state, muscle tissue is elastic and flexion or extension of the limbs occurs without any difficulty. When muscle resistance is felt during flexion and extension, this indicates an increase in their tone.

According to patients, with spasticity there is a feeling of “stiffness” in the muscles.

What's happening?

The internal mechanism of spasticity is not fully understood; according to experts, this disorder occurs as a result of various disorders in the structures of the brain and spinal cord.

Externally, spasticity manifests itself as an increase in tone in muscle tissue, which increases significantly during muscle stretching.

In other words, spasticity provokes muscle resistance during passive movements. It is at the beginning of the movement that the muscle resistance is strongest, and when the speed of passive movements increases, the resistance force increases accordingly.

Muscle spasticity causes changes in muscles, tendons and joints such as fibrosis, atrophy or contracture. This leads to increased movement disorders.

Complex of reasons

The main cause of spasticity is an imbalance in the signals traveling from the brain and spinal cord to the muscles.

In addition, reasons may be:

spinal and spinal injuries;
transferred ;
accompanied by inflammatory processes in the brain (,);
(damage associated with lack of oxygen);
Availability .

Aggravating factors

If a patient has spasticity, the following factors can aggravate the situation:

constipation and intestinal infection;
skin infectious diseases that are accompanied by inflammation;
infectious diseases of the genitourinary system;
clothes that restrict movement.

Regardless of the severity of the disease, these factors can cause the condition to worsen.

Spasticity and spasms

Spasticity is often accompanied by the presence of spasms, which manifest themselves in involuntary contraction of one or a group of muscles. In some cases, spasms are accompanied by pain of varying intensity.

The occurrence of spasms can occur either as a result of exposure to any irritant or independently.

Spasticity can be mild or severe. In the first case, this condition is not a serious hindrance for the patient, and he is able to lead a normal life, whereas in a severe form the person is forced to move in a wheelchair.

It should be noted that the severity of a condition such as muscle spasticity may change over time.

But there are cases of positive effects of spasticity. For example, patients with (weakness) in the legs have the ability to stand independently precisely due to muscle spasm.

Types and types of violation

According to qualifications, three main types of spasticity can be distinguished:

Flexor type called increased tone of the flexor muscles when bending the limbs in the joints and lifting them.
Extenotic type- this is an increase in the tone of the extensor muscles in the process of straightening the limbs in the joints.
TO adductor type include an increase in tone when crossing in the area of the legs and closing the knees.

Pathogenesis of post-stroke spasticity

Spasticity often occurs in patients who have undergone. In such cases, physiotherapy is ineffective, and the presence of spasms complicates the patient’s recovery.

The muscles are constantly toned, pathological changes begin to occur in them, and joints and tendons also suffer. In addition, contractures (deformations) occur, significantly aggravating the problem.

The development of spasticity does not occur immediately; as a rule, it occurs 2-3 months after a stroke, but the first signs can be noticeable to a specialist much earlier.

The shoulders, elbows, wrists and fingers are usually affected, while the lower body is affected by the hips, knees, ankles and toes. In this case, spasticity affects the flexor muscles in the upper extremities, and the extensors in the lower extremities.

In the absence of the necessary treatment, contractures appear in the joints and bones over several years.

Pathogenesis of spasticity in multiple sclerosis

Spasticity is an accompanying phenomenon in most cases. It manifests itself as an unexpected contraction of a muscle group, occurring spontaneously or as a reaction to an irritant.

The severity of muscle spasms in patients with multiple sclerosis can vary, ranging from mild to severe, manifesting as severe and prolonged spasms. The shape of gravity can change over time.

In multiple sclerosis, spasticity occurs in the muscles of the limbs, and in rare cases affects the back muscles.

Evaluation criteria

The severity of spasticity is assessed by points, the most common being the Ashworth scale. In accordance with it, the following degrees of violation are distinguished:

0 - muscle tone is normal;
1 - muscle tone is slightly increased and manifests itself in the initial stages of tension with rapid relief;
1a- a slight increase in muscle tone, which manifests itself in a smaller part of the total number of passive movements;
2 - the tone is increased moderately throughout the entire passive movement, while it is carried out without difficulty;
3 - the tone is significantly increased, there are difficulties in the process of passive movements;
4 - the part of the limb affected does not bend or straighten completely.

Symptoms

The main symptoms of muscle spasticity include:

increased muscle tone;
cramps and involuntary muscle contractions;
the process of deformation in bones and joints;
pain;
posture disorders;
increased reflex activity;
the appearance of contractures and spasms.

In addition to the above, patients with sudden movements experience acute pain in the limbs.

Diagnostic measures

During the diagnostic process, the specialist first of all studies the medical history, as well as what medications the patient is taking and whether any of the patient’s close relatives suffer from neurological disorders.

Spasticity is diagnosed using tests, the essence of which is to assess limb movements and muscle activity during active and passive movements.

When examining the patient, the specialist determines whether there is resistance to the limbs during passive flexion and extension. If resistance is present, this is a sign of spasticity, and increased ease of movement may be a sign of paresis.

Treatment methods depending on the cause

With proper and timely treatment, spasticity can be completely removed. The goal of treatment is to improve the functionality of the limbs and relieve pain.

Treatment methods and medications are selected depending on the severity of the disease, what disorders caused it and how long the patient has been ill.

Treatment is carried out in several areas, namely:

drug therapy;
physiotherapy;
surgical intervention.

Let's look at each method in detail.

Drug treatment

As a rule, several drugs are prescribed, the action of which is aimed at relieving pain and relaxing muscles. Drug therapy is carried out using:

Gabaleptina;
Baclofen;
Imidazoline;
benzodiazepine drugs.

Short-acting anesthetic drugs are also used, for example Lidocaine or Novocaine.

In addition, muscle injections of botulinum toxin may be prescribed. The essence of the treatment is to interrupt the process of nerve transmission, thereby promoting muscle relaxation. The effect of the drug is long-term and lasts several months.

Botulinum toxin is indicated in cases where the patient, for example, after a stroke, does not have muscle contractures. This drug is most effective in the first year of the disease.

Physiotherapy

Physiotherapy methods include:

electrophoresis.

A set of exercises for each patient is selected individually, depending on the condition. It should be noted that exercise therapy is effective in combating spasticity after a stroke.

Massage methods can also be different; in some cases, a massage in the form of light stroking movements is necessary, while other cases require active kneading.

Acupuncture for spasticity has mostly a general effect; the impact of this method on the problem is not so great.

Electrophoresis is prescribed to stimulate muscles with thermal and electrical effects.

Surgical intervention

This method is used in severe cases, for example, if spasticity prevents walking. The essence of the surgical method is the introduction of Baclofen into the cerebrospinal fluid or the suppression of sensitive nerve roots.

In the absence of timely treatment, spasticity has a detrimental effect on the condition of the joints and tendons, provoking atrophy and other pathological changes, for example, the appearance of contractures.

The conclusion is simple and complex at the same time

As for the prognosis, it is individual in each case. The outcome depends on how much muscle tone is increased, what degree severity of the disease and other factors.

Spasticity leads to the appearance of contractures, which can significantly complicate the process of caring for the patient.

As a preventive measure, you should monitor the correct position of the patient’s head, arms and legs. For this purpose, special devices can be used, for example, splints and orthoses.

For quotation: Shirokov E.A. Stroke and muscle hypertonicity // Breast cancer. 2011. No. 15. P. 963

Acute cerebrovascular accidents (ACI) constitute one of the most pressing problems of modern medicine. The number of patients who have suffered a stroke in the Russian Federation is increasing and currently exceeds 1 million people. The most significant consequences of cerebrovascular accidents are associated with movement disorders. Paresis and paralysis, impaired coordination of movements require comprehensive rehabilitation measures aimed at restoring self-care skills and social adaptation. Restoration of lost motor functions occurs quite actively during the first months after a brain stroke, then the rate of recovery decreases. As a rule, the first weeks of the recovery period are characterized by a noticeable decrease in the degree of paresis, an increase in strength and range of movements. However, during this period, many patients experience another problem - muscle tone disorders. Spasticity (C) increases, which significantly limits the results of rehabilitation and often becomes an obstacle to the restoration of motor activity. Tone increases in different muscles to varying degrees. This leads to the fact that the hand acquires a stable position with flexion at the elbow joint and wrist joint. The leg with central paralysis, an important sign of which is hypertonicity, on the contrary, most often turns out to be straightened. Spasticity leads not only to the formation of stable pathological postures, but also contributes to pathological changes in the joints. As a rule, patients suffer from arthrosis and ankylosis, joint pain no less than from paresis.

The development of C in cases of damage to the structures of the central nervous system is associated with a decrease in inhibitory effects on spinal motor neurons. The decrease in inhibitory effects on spinal structures is explained by combined damage to the pyramidal and extrapyramidal tracts of the brain, while an important role in the development of spasticity is attributed to damage to the cortico-reticulospinal tract. In conditions of weakening of corticospinal stimuli, dysfunction of the extrapyramidal system can usually be observed. One of the leading mechanisms of C formation should be considered the disinhibition of the tonic stretch reflex. Secondary changes in the muscles, tendons and joints that occur with muscle hypertension increase movement disorders; therefore, resistance to passive movement depends not only on disturbances in muscle tone, but also on muscle changes, in which signs of atrophy can often be found. An isolated lesion of the pyramidal tract, as a rule, does not cause hypertonicity, but only leads to paresis. However, with stroke, damage usually occurs not only to the pyramidal tract, but also to other structures, such as the cortico-reticular-spinal tract, which leads to inevitable disturbances in muscle tone. If post-stroke paresis persists for a long time (several months or more), then structural changes in the segmental apparatus of the spinal cord may occur (shortening of the dendrites of motor neurons and collateral sprouting of afferent fibers that are part of the dorsal roots), which contribute to a sustainable restructuring of the motor stereotype. This is facilitated by secondary changes in the muscles, tendons and joints, which increase the resistance that occurs in the muscle when it is stretched. Knowledge about the pathogenesis of tonic disorders arising in connection with stroke is necessary to understand the mechanisms of action of drugs, most of which have a so-called central mechanism of action.
It is possible to detect the first signs of increasing muscular-tonic disorders already in the first hours after a stroke. They are often characterized by a decrease in muscle tone. However, after a few days, spasticity becomes noticeable and increases along with the restoration of movements. The functional state of the muscles and muscle tone are assessed during a standard neurological examination of the patient, during the observation of active movements, and during passive changes in the position in space of body parts. Spasticity is characterized by increased muscle tone, which prevents the expansion of range of motion. Each time when performing the simplest movements, the patient has to overcome the resistance of tense muscles, which aggravates the picture of paresis or paralysis. A characteristic clinical sign of C is its change during the study - the tone increases with passive stretching of the muscle, and the increase in muscle resistance directly depends on the speed of passive movement. A common sign that reveals dystonia is uneven muscle tone during flexion and extension of the limb - the “jackknife” phenomenon. The degree of muscle tone disorders can vary significantly during the day, under the influence of external and internal factors (weather, emotional state of the patient, ambient temperature). Patients who have suffered a stroke are characterized by changes in tone depending on the position of the limb, physical activity, its nature and intensity. Hypertonicity can delay recovery after a stroke, since with severe muscular dystonia, the patient’s daily activity is limited to the confines of the bed: with any attempts to move to a vertical position, persistent muscle tension prevents movement and forces the patient to return to a horizontal position. Other complications of the post-stroke period also arise - limited mobility in the joints, arthrosis-arthritis and associated pain syndromes. Muscular dystonia has a significant impact on the statics of the spine, which in some cases becomes an independent problem (lumbodynia, thoracalgia, vertebrogenic radiculopathies). One of the most important questions that must be addressed when managing a patient with post-stroke spasticity comes down to the following: does high muscle tone worsen the patient’s functional capabilities? In general, limb functionality in patients with post-stroke limb paresis is worse in the presence of severe spasticity than in mild spasticity. However, in some patients with a severe degree of paresis, spasticity in the leg muscles can make standing and walking easier, and its decrease can lead to deterioration in motor function and even falls. Before you begin to correct hypertonicity, it is necessary to determine treatment options in this particular case (improving motor functions, reducing painful spasms, facilitating patient care, etc.) and discuss them with the patient and (or) his relatives. Treatment options are largely determined by the time since the disease and the degree of paresis, the presence of cognitive disorders. The shorter the time since the stroke that caused spastic paresis, the more likely it is to improve. With a long duration of the disease, a significant improvement in motor functions is less likely, however, it is possible to significantly facilitate patient care and relieve the discomfort caused by S. The lower the degree of paresis in the limb, the more likely it is that treatment will improve motor functions. For clinical assessment of muscle tone and monitoring the effectiveness of treatment, the modified Ashworth scale is used for practical purposes (Table 1).
The principles of spasticity correction in the post-stroke period are based on the following principles:
- pathologically increased muscle tone should be reduced in all cases to prevent irreversible changes in muscles and joints and speed up the rehabilitation process;
- treatment should be started as early as possible, when the first signs of C appear;
- the duration of treatment is determined by the restoration of the patient’s motor activity.
Drug therapy for muscle dystonia in patients who have suffered a stroke is based on the use of muscle relaxants. Before prescribing muscle relaxants, it is necessary to establish how much increased muscle tone makes movement difficult. In some cases (especially in the early recovery period), hypertonicity helps the patient maintain support on the paretic limb - then the prescription of muscle relaxants can be delayed. However, this feature usually requires attention for a short period of time - during the patient's first attempts to restore walking skills. In the future, a decrease in muscle tone plays a more important role in comprehensive rehabilitation programs, as it allows for an increase in range of motion.
Tolperisone is most often used to treat spastic syndromes. In its chemical structure, the drug is close to lidocaine. The action of the drug is based on the blockade of polysynaptic spinal reflexes. In addition, the drug has a central anticholinergic effect, has antispasmodic and moderate vasodilator activity. Tolperisone reduces increased muscle tone and muscle rigidity during spastic paresis, improves voluntary active movements, normalizes peripheral circulation, and has a membrane-stabilizing, local anesthetic effect. Its use in adequate doses leads to increased local blood circulation. The main contraindication for use is myasthenia gravis and lidocaine intolerance. Typically, the start of treatment occurs in the 2-3rd week of a stroke - the period of activation of the patient. When the first signs of spasticity appear, 50-100 mg of the drug per day is prescribed, which in most cases facilitates movement. In later periods of the disease, with the formation of persistent spastic paresis, higher doses of muscle relaxants are required. In severe cases of increasing spasticity, intramuscular administration of the drug 100 mg 2 times a day is used. Tablets of 50 and 150 mg allow you to act in a wide range of therapeutic doses to achieve the desired effect. The vasodilating effect of tolperisone may be useful in cases of severe atherosclerotic changes in the vessels of the lower extremities. The drug combines well with non-steroidal anti-inflammatory drugs. It is important to note that the drug does not cause general muscle weakness. Tolperisone does not have a sedative effect.
Other agents are used to correct spasticity of various origins: tizanidine, baclofen, dantrolene and benzodiazepines. The basis for the use of these antispastic drugs (or muscle relaxants) are the results of double-blind placebo-controlled randomized studies that have shown the safety and effectiveness of these drugs. An analysis of studies comparing the use of various antispastic agents for a variety of neurological diseases accompanied by spasticity showed that tizanidine, baclofen and diazepam are approximately equally capable of reducing spasticity.
In stroke patients who have local spasticity in paretic muscles, botulinum toxin type A or botulinum toxin can be used. The effect of botulinum toxin when administered intramuscularly is caused by blocking neuromuscular transmission. The clinical effect after injection of botulinum toxin is observed after a few days and lasts for 2-6 months, after which a second injection may be required. The best results are observed when using botulinum toxin in the early stages (up to a year) from the moment of illness and with mild paresis of the limb. The use of botulinum toxin may be especially effective in cases where there is a foot deformity caused by spasticity of the posterior calf muscles, or high tone of the flexor muscles of the wrist and fingers, which impairs the motor function of the paretic hand. Repeated injections of botulinum toxin in some patients give a less significant effect, which is associated with the formation of antibodies to botulinum toxin and blocking its action. The limited use of botulinum toxin in clinical practice is largely due to the high cost of the drug.
Treatment with muscle relaxants begins with a minimum dose, then it is slowly increased to achieve effect. Antispastic agents are usually not combined.
Surgical treatment for post-stroke spasticity is also possible. Surgeries to reduce spasticity are possible at four levels - the brain, spinal cord, peripheral nerves and muscles. Brain surgeries include electrocoagulation of the globus pallidus, ventrolateral nucleus of the thalamus, or cerebellum and implantation of a stimulator on the surface of the cerebellum. A longitudinal dissection of the conus (longitudinal myelotomy) can be performed on the spinal cord to sever the reflex arc between the anterior and posterior horns of the spinal cord. The operation is used for spasticity of the lower extremities; it is technically complex, associated with a high risk of complications, and therefore is rarely used. A significant part of surgical operations in patients with spasticity of various origins is performed on muscles or their tendons. When contracture develops, surgical intervention on the muscles or their tendons is often the only method of treating spasticity.
So, drug correction of muscular dystonia is carried out mainly with muscle relaxants, but in necessary cases, to reduce muscle tone, it is possible to use representatives of other drug groups that act on different levels of the pathological process. In each specific case, the treatment regimen and dosage of medications are determined individually.
It should be noted that the correction of muscle-tonic disorders is achieved through complex treatment, which includes properly organized and systematic physical therapy, massage, and reflexology. Several types of exercise are usually recommended for stroke patients. So-called general tonic and breathing exercises (helping to improve the general condition of the body), exercises to improve coordination and balance, to restore the strength of paralyzed muscles, as well as techniques to reduce muscle tone are used. Along with therapeutic exercises, positioning or positional treatment is also used, in which the patient is placed in bed in a special way so as to create the best conditions for restoring the functions of his arm and leg.

Literature
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3. Formisano R., Pantano P., Buzzi M.G. et al. Late motor recovery is influenced by muscle tone changes after stroke // Arch Phys Med Rehabil. - 2005; 86: 308-11.
4. Shirokov E.A. Sirdalud in the complex therapy of chronic pain syndromes//RMZh, 2006; 4:240-242.
5. Coward D.M. Tizanidine: Neuropharmacology and mechanism of action. //Neurology. 1994;11(9):S6-S11.
6. Hutchinson D.R. Tizadinine with modified release (review).//RMZh, 2007;12: 1-4.
7. Kadykov A.S. Rehabilitation after a stroke. M.: Miklos Publishing House. - 176 p.
8. Gelber D. A., Good D. C., Dromerick A. et al. Open-Label Dose-Titration Safety and Efficacy Study of Tizanidine Hydrochloride in the Treatment of Spasticity Associated With Chronic Stroke // Stroke. 2001; 32: 2127-31.
9. Kamchatnov P.R. Spasticity - modern approaches to therapy. http://www.medlinks.ru/article.php?sid=20428
10. Bakheit A.M., Thilmann A.F., Ward A.B. et al. A randomized, double-blind, placebo-controlled, dose-ranging study to compare the efficacy and safety of three doses of botulinum toxin type A (Dysport) with placebo in upper limb spasticity after stroke // Stroke. 2000; 31: 2402-06.
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Get rid of spasticity after a stroke. How to get rid of spasticity after a stroke? Signs of seizures after a stroke

Development mechanism

Treatment

Patient position

Massage

Physiotherapy

Muscle relaxants

Treatment with botulinum toxin

Finally

Restorative set of exercises for hands

Initial rehabilitation period

Speed ​​of rehabilitation

Spasticity. Part 1.

Treatment of spasticity after stroke

Development mechanism

Treatment

Patient position

Massage

Physiotherapy

Muscle relaxants

Treatment with botulinum toxin

Finally

Post-stroke spasticity

Hand spasticity after stroke

Mom has a stroke. Treatment and rehabilitation after stroke.

Articles

Exercises to restore movement in the hand

What's happening?

Complex of reasons

Aggravating factors

Spasticity and spasms

Types and types of violation

Pathogenesis of post-stroke spasticity

Pathogenesis of spasticity in multiple sclerosis

Evaluation criteria

Symptoms

Diagnostic measures

Treatment methods depending on the cause

Drug treatment

Physiotherapy

Surgical intervention

The conclusion is simple and complex at the same time

Speed of rehabilitation