Spasticity and Paralysis
Mobility Issues Facing Stroke Survivors and Their Families
Moving around safely and easily is not something
you may think about, unless you have had a stroke. Each year more than
750,000 Americans suffer strokes. In some instances paralysis and/or
balance problems may result. One out of every three Americans age 65 and
older falls. Ten percent of those individuals fracture a bone, dislocate
a joint or experience other serious injuries due to their balance and/or
paralysis problems. This booklet provides helpful information about home
adaptations and lifestyle changes that may increase your safety and
ability to move more easily.
Understanding Paralysis and Spasticity
Paralysis is the inability of a muscle or group of
muscles to move voluntarily. When messages from the brain to the muscles
don't work properly due to a stroke, a limb becomes paralyzed or
develops a condition called spasticity.
Spasticity is tight, stiff muscles that make
movement, especially of the arms or legs, difficult or uncontrollable.
Characteristics of the condition can include any of the following: a
tight fist, bent elbow, arm pressed against the chest, stiff knee and/or
pointed foot that can interfere with walking. These long periods of
forceful contractions in major muscle groups can cause painful muscle
spasms. The spasms produce a pain similar to athletic cramping.
What are the Symptoms or Effects of Spasticity?
· Stiffness in the arms, fingers or legs
· Painful muscle spasms
· A series of involuntary rhythmic contractions and relaxations in a
muscle or group of muscles that lead to uncontrollable movement or
jerking, called clonus
· Increased muscle "tone"
· Abnormal posture
· Hyperexcitable reflexes
Treatment for spasticity is often a combination of many therapies and
medications. This approach is used to achieve the best function
possible. It's important to remember that all therapies and drugs may
have potential side effects that should be weighed against their
benefits. Patients need to discuss appropriate options with their
Stretching and Temporary Strategies
Spasticity treatment often includes full range-of-motion exercises at
least three times a day; gentle stretching of tighter muscles; frequent
repositioning of body parts and splinting or casting.
Oral medications are available to treat the general effects of
spasticity by acting on multiple muscle groups in the body. Side effects
may range from drowsiness and confusion to depression and liver
abnormalities, among other things.
Injections using Botulinum Toxin Type A (Botox®) or Phenol relax stiff
muscles by blocking the chemicals that make them tight. While oral
medications affect multiple muscle groups in the body, these injections
target only specific limbs or muscle groups affected by spasticity. A
single injection can relax affected muscles for three to six months and
improve some activities of daily living. Since the medication is
targeted to affected muscles, side effects are minimized. Side effects
may include mild soreness at injection site and temporary fatigue.
ITB (Intrathecal Baclofen) Therapy delivers Lioresal Intrathecal, a
liquid form of the drug Baclofen, directly into the spinal fluid. A
programmable pump is surgically placed just below the skin near the
abdomen where it continuously delivers small doses of medication. Since
the drug is delivered to affected areas and does not circulate
throughout the body, side effects are minimized. Possible side effects
include drowsiness, nausea and headache.
Neurosurgery and orthopedic surgery are generally used as last resorts
for spasticity treatment. Surgery may help block pain and restore
movement to limited degrees.
Healthcare providers should try to customize
spasticity treatment, taking into consideration the extent of the
problems, individual symptoms and personal lifestyle goals.
Safety at Home
Stroke survivors and caregivers may be apprehensive about being on their
own at home. With some simple modifications and education, fears can be
overcome and recovery enhanced.
Modifying home environments with assistive devices, such as grab bars
and ramps, may provide additional safety and easier movement around the
Other useful devices:
· Raised toilet seat
· Tub bench
· Hand-held shower head
· Plastic adhesive strips on the bottom of the tub
· Long handled brushes, washing mitts with pockets for soap
· Electric toothbrushes and razors
Many areas of the home can be made safer if throw
rugs and furniture are removed or securely fastened to the floor.
Braces, canes, walkers and wheelchairs may also help stroke survivors
gain strength and move about more freely. It is important to use the
braces or other devices exactly as a therapist recommends.
Foot drop is a common problem during stroke
recovery. The condition is caused by a person's foot or ankle dropping
down when lifting a leg to take a step. It may cause a person to trip
and fall if the foot and ankle are not supported by a brace at all
The most common brace for this long-term problem is
an ankle-foot orthosis (AFO). The AFO starts below the knee and
encompasses and controls the ankle and foot. Certain types of these
braces or adjustments to these braces can also influence knee movement.
Other variations and adjustments can be made to braces to fit individual
A physical therapist or orthotist can recommend the
appropriate device. Training in safety procedures and the proper use of
orthotics, including proper fit and maintenance, is essential.
Lifestyle Can Affect Safe Movement
Lifestyle modifications in relation to diet and exercise should be
individualized to meet a person's specific environment and needs. Weak
leg muscles, poor vision, dizziness and medications that may compromise
balance may put people at risk for falls. Your health care provider
should be aware of the symptoms and help provide guidance regarding
dosage and side effects.
You can also prevent falls by:
· Remaining active
· Strengthening leg muscles and balance through weight training and/or
Tai chi classes
· Wearing flat, wide-toed shoes
· Eating calcium-rich foods and taking calcium supplements, if
necessary, to increase bone strength
· Following your therapists' recommendations regarding limitations and
· Not relying on furniture for support while walking. Use the assistive
device prescribed by your therapist
· Recognizing that certain medications may make you drowsy, and taking
· Limiting walking when distracted
· Never walking without prescribed assistive aids such as braces
Be on the safe side and don't take chances. Listen
to the advice of healthcare professionals and experienced caregivers.
Regaining independence requires patience.
This page from The National Stroke Association
is sponsored by an unrestricted educational grant from Medtronic, Inc.