Spasticity and Contractures?

The involuntary tightening and stiffening of muscles is called spasticity. Due to these involuntary movements in muscles joints get fixed in abnormal positions. With the time contractures get hard and in children can lead to the growth of deformed limbs. In case of severe deformity which takes place in Old unattended PwSCI and growing children.

NEUROPATHIC PAIN: Spinal cord injury and neuropathic pain go together. Complete spinal injuries result in less severe neuropathic pain as compared to incomplete spinal trauma. Reason is obvious for the communication of brain and affected parts of body are interrupted at and below the sight of Sci. Hot and Cold pads help in reducing neuropathic pain but it is not advisable for persons with spinal cord injuries because its huge risky to apply below the level of injury because those areas dont have 100% sensation and it can damage the skin and lead to bedsore. If PWSCI seriously required it then we should connect them with a therapist and guide in the proper way.

Spasticity is a condition in which there is an abnormal increase in muscle tone or stiffness of muscle, which might interfere with movement, speech, or be associated with discomfort or pain. Spasticity is usually caused by damage to nerve pathways within the cerebral cortex or spinal cord that control muscle movement. It may occur in association with spinal cord injury, multiple sclerosis, cerebral palsy, stroke, brain or head trauma, amyotrophic lateral sclerosis, hereditary spastic paraplegia and metabolic diseases such as Krabbe disease etc.

Symptoms may include hypertonicity (increased muscle tone), clonus (a series of rapid muscle contractions), exaggerated deep tendon reflexes, muscle spasms, scissoring (involuntary crossing of the legs), and fixed joints (contractures). The degree of spasticity varies from mild muscle stiffness to severe, painful, and uncontrollable muscle spasms can be measured on Ashworth scale. Spasticity can interfere with rehabilitation in patients with certain disorders, and often interferes with daily rehabilitation program and it can lead to contractures and deformity as well if untreated.

Are spasms good or bad?

Spasms are really something brilliant to have. They are like the second brain for PWSCI. A brain that functions at and below the level of our injury and indicates what's happening below the level of our injury. In some cases, spasms can be very extreme; in which case it can hamper activities of daily living, but that can be managed with medication and with the proper exercises. In this way, we can say, spasms are good
up to some extent which can be manageable, in that stage, the spasms are like a second brain for PWSCI. At the level of the injury, it can stay for a long time.

How spasms helps to understand health condition?

Every time when something goes wrong on below the level of injury, the spasm give an amazing warning signal. If we have suffering from fever or urine infection or urine is going to leak or stool is going to come out, or catheter blockage or it could be any internal health-related issue below the level of injury, and along with all these internal issues, if any external problems also occur like ants bite, rat bite, pressure in bedsore, pin type things pricked below the level of injury or anything painful happen below the level of injury, then at that time spasticity gives us an indication of something is going wrong in our body below of our injury level, and at that time spasms will be different from the normal level, intensity of spasms will be different. It can take over the years for a person to understand the normal level of his/her spasms. Depending on the extremity of the problem, the spasticity can be extremely high; legs can become stiff to extremely stiff. So, all the indications are helped us to understand our body condition below the level of injury. Benefit of Spasms
Spasms also give a fair bit of benefits apart from sending signals about what's going wrong below the level of injury in our body. If anyone has spasms then such spasms have helped maintain the tone and tenor of leg muscles. So, somebody who does not have any spasm, that is called a flaccid condition. So, If we compare the legs between a spastic person and a flaccid person who does'nt have any spasticity, even if that person walk, we will see that the leg of the spastic person is in much better shape than the leg of the flaccid condition
person. Spastic persons leg will be in very good shape in terms of muscle preservation, preservation of the tone, where as a flaccid person's legs will lose that tone and just left with only bone and skin. So this is one area where spasms significantly helped. There are cases who suffer from both spasticity as well as atrophy (muscle loss) which makes every case a unique case. Here it is important to mention that good protein diet and consistent exercises are necessary to retain the muscle volume and tone. In some cases PwSCI need to tie the legs with belts on to the wheelchair to prevent a sudden


How to manage spasms?

There are also some people whose normal levels of spasms are so intense that it can hinder their day to day activities. The spasticity level of a quadriplegic person is much higher than the paraplegic person. The care is a long term process involving physical therapists, caregivers and patient itself. Oral medications are supported by ADL, Splinters, injections and a continued therapy by a qualified
physiatrist. Till date there's no complete cure to the spasticity though some drugs are prescribed to mitigate the severity by spasticity. So, they need to be on medication and the medicine has to be taken in consultation with a good physiatrist. All the medicine of spasms is basically sedative in nature. So, excessive dosage of medicine will also lead to a sleepy outcome throughout the day. Over a period of time, PWSCI must learn to find out non-medical ways of managing their spasms. The ways of reducing spasms without medication is to stretch the legs with passive exercises, stretches the hamstring, the adductor and the calf muscles. Stretches will help to reduce spasms up to some extent. The PWSCI who stands for one hour with the Caliper, Walker, Clutch, or in standing table can be helpful for them in reducing spasms. But walking with the help of a caliper, walker, or crutches also helps a lot in managing spasms; the effect of it on reducing spasms is lasting for a little longer than standing, because when we walk, there is a lot of movement on the legs at that time which helps in reducing spasticity. Person with spinal cord injuries who are into swimming, for them swimming is very helpful in reducing spasms because inside the water, a person almost feels no weight and spasms magically disappear but in some cases, if the person does not swim any day then that day the spasms return again. But basically who are on the swims, they doesn't need to take any of the sedative medications that usually takes for spasms, or they takes only a very minimal dosage of those medicines. So, swimming is also another
excellent way of reducing spasms. But never go for any other types of massages to heal and manage the spasms, which can be counterproductive. Live active life with spasms So, facing such situations and doing activities we can understand our body, understand what signals our body is sending us through spasms, and once we learn to understand those signals then we can be able to manage our spasms with minimal medication. We will also be able to quickly identify what has gone wrong below the level of our injury and take action to heal the damage. So, we don't need to live in fear of spasms if we start to understand our bodies and observe the changes of spasms. For most people with a spinal cord injury, spasms are more of a help than a hindrance. In conclusion, we can conclude that the most important thing to lead an active life with spasms is to understand spasm.