Spasticity and Paralysis

REGAINING INDEPENDENCE

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 Options
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 healthcare provider.

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
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
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.

Intrathecal Medication
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.

Surgery
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.

Assistive Devices
Modifying home environments with assistive devices, such as grab bars and ramps, may provide additional safety and easier movement around the home.

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.

Movement Aids
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 times.

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 needs.

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 walking needs
· 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 precautions
· 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.