Muscle spasticity and its treatment. What is it, the causes of spasticity, prevention and treatment of spasticity of the fingers after a stroke

Depending on the area of the brain affected by the stroke, some body movements, speech, and body functions may change. Individual areas of the brain have their own functions and control specific parts of the body. The prognosis for a stroke patient depends on the location of the disease and the severity of the brain damage. This is known to be common in arms that become weak after a stroke. Using medications and the right exercises to strengthen your muscles can restore control and strength to your arm muscles, returning you to a normal person.

Steps

Part 1

regaining strength through exercise

Develop your shoulders. According to the American Heart Association, reusing affected body parts such as the arms, hands and fingers reveals new ways of communication between the brain and the affected area. Movement and physical therapy help stroke patients retrain their brains to use fine motor skills. Exercises for shoulder development are as follows:

Shoulder flexion. Holding a dumbbell in your hands, keep your elbow straight and raise your arm above your head and lower it down. Repeat this exercise ten times. Take the dumbbell in your other hand and repeat the same exercise. Do it at least once a day.
Shoulder abduction. Hold the dumbbell in one hand, keeping it straight. Then move your arm to the side at shoulder height. Return your hand to yourself. Repeat this ten times and then switch to the other hand. Repeat this exercise at least once a day as well.

Also work on your elbows. Here are two exercises you can do to strengthen your elbows, forearms, and hands:
- Elbow spread. Lean forward slightly and keep your elbows behind you. Raise the dumbbell behind you, keeping your elbows straight, and then bend them. Repeat this ten times, and then switch hands and repeat on the other side.
- Elbow bending. Hold the dumbbell with one hand. Then, bend your arm at the elbow, and then straighten it. Repeat this ten times. Switch sides and repeat, or perform the exercise on both elbows at the same time.
Also make turns. To strengthen your arms, hands, and fingers and strengthen your muscles, you can do twists in addition to flexion and extension exercises. Here are two types of twist exercises that will help strengthen your muscles:
- External spreads. Take an elastic rubber band in your hands. Start the exercise with your elbows bent 90 degrees to your body. Rotate your arms by turning your palms to the sides. Repeat this ten times. Do it at least once a day.
- Internal rotations. Tie one end of the elastic to the doorknob. Then, keeping your elbow at a 90-degree angle, pull the other end towards your stomach. Do this exercise at least once a day as well.
Strengthen your wrists. Exercising your wrists by using a dumbbell is considered a weight-bearing exercise. This type of physical activity produces new bone tissue and makes your bones stronger. As blood flow increases with exercise, muscle mass and strength also increase. The following can be done:
- Hold a dumbbell in both hands with your elbows bent 90 degrees. Rotate your palms up and down ten times. Do this exercise at least once a day.
- With your palms facing down, hold a dumbbell in each hand and bend your elbows to 90 degrees. Raise your wrists up and down while keeping your elbows in the starting position. Repeat this ten times. As always, do this at least once a day.
Understand the essence of these exercises. Exercises such as shoulder flexion and abduction, elbow flexion and extension, and external and internal rotations work the muscles of the arms, elbows, wrists, and shoulders. Exercising the injured body part through pulling, pushing or lifting stimulates muscle growth and increases its efficiency. Regular exercise increases the number of myofibrils (muscle fibers) in each cell, which accounts for 20 to 30% of muscle growth.
- Due to increased blood flow, more oxygen and nutrients are delivered to the muscle fibers, leading to increased muscle mass. An increase in muscle mass leads to an increase in muscle strength. When muscles begin to work, they develop more mitochondria, small power plants that convert chemical energy into energy used by cells.
Part 2
using a medication approach
1. Take 40 to 80 mg of baclofen (Lioresal) every day. This drug acts on the central nervous system, preventing nerve impulses in the brain that cause muscles to contract. It relaxes muscles, reducing muscle spasms, tightness, pain, and increases range of motion. For adults, the required dose of baclofen is 40-80 mg/day for four separate doses.
  - An analogue of the drug baclofen is dantrolene sodium (Dantrium). The recommended dose is 25 mg to a maximum of 100 mg three times daily.
2. Try 8 mg of tizanidine hydrochloride (Zanaflex) every 6 or 8 hours. This drug also blocks nerve impulses in the brain that cause muscles to contract. The ideal starting dose is 4 mg every 6 or 8 hours. The maintenance dose is 8 mg every 6 or 8 hours.
  - However, the effectiveness of the drug only lasts for a short period of time, so it is advisable to use it as needed to relieve discomfort and enable you to perform certain activities.
3. Consider taking benzodiazepines such as Valium and Klonopin. This type of medicine acts on the central nervous system, thereby relaxing the muscles and reducing spasticity within a short period of time.
  - The oral dose varies because benzodiazepines go by different names (in other words, there are different medical names for the drug). Consult your doctor to determine the appropriate formulation.
4. Consider receiving botulinum toxin (Botox) injections to reduce spasticity. Botox injections attach to nerve endings and block the release of chemical messengers that signal the brain to activate muscle contraction. Essentially, the treatment prevents muscle spasms.
5. As an alternative, consider phenol injections. Phenol destroys nerve conduction, which causes spasticity. It is used as an injection directly into the affected muscles or into the spine. Dosage may vary depending on the manufacturer.
  - Talk to your doctor about whether this course of treatment is right for you. Phenol injections are not suitable for all stroke patients.
6. Talk to your doctor about electrical stimulation therapy. This therapy stimulates affected nerve endings in the brain to cause muscles to contract. This therapy helps restore movement and control of the arms and hands, improves muscle tone and reduces pain in the patient after a stroke. It also increases blood flow to the brain to speed healing and reduce swelling, improves the flow of medications to the skin, and reduces muscle spasticity.
  - Again, electrical therapy is not for everyone. Only your doctor will know if this procedure is right for you.
7. Consult a physical therapist to begin muscle therapy. There are two types of muscle recovery that you may want to consider:
  - Limited-induced movement therapy. This therapy is often performed during rehabilitation to increase the brain's ability to heal itself and the affected hands to regain their function. Movement of the unaffected arm is restrained by the device to allow the injured arm to be used for as many activities as possible.
  - Rehabilitation therapy. Rehabilitation therapy (RT) helps a patient after a stroke relearn his daily activities that were familiar to him before the illness. This will speed up your recovery as you learn to live and work with disabilities. The doctor will help you re-equip your home for safer and easier movement inside it.
8. Work with your stroke rehabilitation team to determine which treatment is best for you. Putting your strength back into your hands doesn't mean you rely exclusively on one medication or treatment. During stroke rehabilitation, you and the rehabilitation team will work together to determine which medications work well and what improves stroke stiffness in your hands.
  - Medicines are not a panacea for stroke: they only relieve the symptoms of spasticity that binds the muscles. Muscle spasticity causes pain, changes body position, and leads to uncontrolled movements. The arms may begin to regain their normal strength and range of motion if medications taken by the patient relieve the spasticity.
Part 3
understanding your condition
1. Be aware of the type of stroke you have had. When blood flow to an area of the brain is obstructed, it leads to the development of a stroke. Brain cells that are not supplied with blood die due to lack of oxygen. In a matter of minutes and without warning, a stroke can occur and affect a person. There are two types of stroke:
  - Ischemic stroke. This is the most common type of stroke. About 87% of stroke patients suffer from this type. It develops due to a blood clot in a blood vessel that causes an interruption in the flow of blood to the brain. It can also be caused by emboli, or a blood clot that travels to other parts of the body.
  - Hemorrhagic stroke. Rupture of blood vessels on the surface of the brain that fill the space between the skull and brain leads to hemorrhagic stroke. A hemorrhagic stroke can also be caused by a ruptured artery in the brain, which causes bleeding into nearby tissue.
2. Find out what symptoms may be caused by a stroke. Stroke patients may experience weakness on one side of the body, either the arms or legs, or both parts of the body. There may also be speech problems, vision, memory and mental problems, difficulty swallowing, urinary incontinence and bladder problems. In a severe case of stroke, paralysis or even death can occur.
  - Hands and hands may become especially sensitive after a stroke. A patient with a stroke may experience spasticity, uncontrollable clenching and stiffness of the muscles, which causes difficulty in moving the arm and palm. The injured arm or leg is on the opposite side of the body from the part of the brain affected by the stroke.

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
1. Gusev EI. The problem of stroke in Russia. Journal of Neurology and Psychiatry. S.S. Korsakova (STROKE supplement to the journal). 2003; 9:3-7.
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. 108-123.
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 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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Owners of patent RU 2428964:

The invention relates to restorative medicine. For 20-30 minutes, with the patient's forced maximum exhalation, the doctor performs passive stretching of the spasmodic muscle of the limb, combined with rotation of the hand or foot alternately in both directions, and maintains the stretching phase until the end of exhalation. Exercises are carried out for 3 weeks. The method provides a reduction in muscle spasm and normalization of muscle tone.

The invention relates to the field of medicine, namely to restorative medicine.

Strokes remain an important medical and social problem, being one of the main causes of long-term disability in people of working age. In Russia, among patients who have suffered a stroke, no more than 3-23% return to work; 85% of patients require constant medical and social support. Due to the lack of timely and adequate restorative treatment, leading to irreversible anatomical and functional changes, almost a third remain disabled (Kovalchuk V.V. Principles of organization and effectiveness of various methods of rehabilitation of patients after a stroke: abstract of thesis... Ph.D. - St. Petersburg, 2008. - P.3.).

During the first three months after a stroke, muscle tone increases in paretic limbs, and although at the first stage mild or moderate spasticity, for example, in the extensors of the lower extremities, will only contribute to the restoration of walking function, in most cases this progressive increase in tone will lead to the development of muscle contractures, which are combined with periodic painful attacks of muscle spasms. Subsequently, trophic changes occur in the joints of the paretic limbs and joint contractures develop. The spastic state of the muscles is a significant obstacle to the restoration of motor functions, leads to loss of ability to work, self-care skills and sharply reduces the quality of life of patients who have suffered a stroke (Kadykov A.S., Chernikova L.A., Shakhparonova N.V. Rehabilitation after stroke // Atmosphere, Nervous Diseases, 2004, No. 1, pp. 21-23).

Combating muscle spasticity and restoring normal muscle tone is an important and necessary component of motor rehabilitation of patients who have suffered a stroke.

There are known methods of restorative medicine aimed at reducing muscle spasticity:

A method of reducing muscle spasm using positional treatment by placing the arms and/or legs for 2-3 hours in a special position opposite to the Wernicke-Mann position (Kadykov A.S., Chernikova L.A., Shakhparonova N.V. Rehabilitation after stroke // Atmosphere. Nervous diseases. - 2004. - No. 1. - P. 23.);

A method of reducing muscle spasms using physiotherapy, including heat treatment with paraffin or ozokerite applications and/or cold treatment (Kadykov A.S., Chernikova L.A., Shakhparonova N.V. Rehabilitation after a stroke // Atmosphere. Nervous diseases. - 2004. - No. 1. - P.23);

A method of treating post-stroke conditions, including daily therapeutic massage of the spinal area with elements of acupressure and manual therapy of the cervicothoracic spine, pre-cooling the spinal area with compresses, performing a therapeutic massage of the limbs with elements of acupressure from the knee along the back of the thigh and cooling the limbs with compresses, after which lymphatic drainage from the knee up to the pelvis and from the foot to the knee (Patent No. 2289380 RF, IPC A61N 1/00. Method of treatment of cerebral ischemic stroke, hemorrhagic stroke and post-stroke conditions. Badaev B.B. / Badaev Boris Borisovich, publ. 20.12. 2006);

A method for the prevention of patients who have suffered a stroke, due to daily exposure for 8 days to an electric field with voltage U, determined by the law: U = -1.5 kV + 0.5 kV sin 78.5t, with a frequency of 12.5 Hz, supplementing it with evening relaxation exercises (Pat. No. 2308984 of the Russian Federation, IPC A61N 1/20. A method of preventing patients who have had a stroke, performed in a home hospital. Romanov A.I., Khatkova S.E., Panteleev S.N., Savitskaya N.N., Doroshenko G.P., Shamin V.V., Matveeva E.V. / Limited Liability Company "Epidavr". Publ. 10/27/2007);

A method for reducing increased muscle tone in cerebral palsy as a result of combined transspinal micropolarization and magnetic pulse stimulation (Pat. No. 2262357 RF, IPC A61N 1/20. A method for reducing increased muscle tone in cerebral palsy. Sirbiladze K.T., Pinchuk D. .Yu., Petrov Yu.A., Iozenas N.O., Yuryeva R.G. / State educational institution of higher professional education St. Petersburg State Academy named after I.I. Mechnikov. Published 10.20.2005.);

A method for normalizing muscle tone in children with spastic forms of cerebral palsy by relaxing the child on a not fully inflated ball, laying it face down, while one methodologist fixes his shoulders on the surface of the ball, his arms symmetrically along the body, another methodologist fixes the lower limbs on the surface ball and, as relaxation is achieved, separates them, performing slow rocking back and forth, left and right and in a circle, then perform stretching exercises for the child’s limbs and torso symmetrically, with the same effort, in the same horizontal plane, sequentially, starting with the upper limbs and shoulder girdle (Pat. No. 2289381 RF, MPC A61N 1/00. Method for normalizing muscle tone in children with spastic forms of cerebral palsy. Kozhevnikova V.T., Sologubov E.G., Polyakov S.D., Smirnov I.E. / State institution Scientific Center for Children's Health of the Russian Academy of Medical Sciences (State Scientific Center for Children's Health of the Russian Academy of Medical Sciences), State Children's Psychoneurological Hospital No. 18 of the Moscow Department of Health. Publ. 12/20/2006);

A method for reducing muscle spasticity as a result of being in positions: lying on your back, on a bolster and on your stomach, supporting your lower jaw with your palms (Kachesov V.A. Fundamentals of intensive rehabilitation. - M., 1999. - P.76);

A method of relaxing a spastic muscle by performing a massage in the form of stroking, rubbing, shaking, kneading segmental zones (Belova A.N. Neurorehabilitation. - M.: Antidor, 2000. - P.163);

A method of relaxing a spastic muscle with the help of therapeutic exercises, exercises aimed at relaxing muscles, by using the weight of the limb to swing or lower it freely, and suppressing pathological synkinesis by eliminating vicious concomitant movements (Belova A.N. Neurorehabilitation. - M.: Antidor, 2000. - P.107);

A method of reducing the spasticity of a limb by fixing the limb and the doctor performing a movement towards the spasticity of the contracting muscle, with bending and rotation of the contracting muscles (Kachesov V.A. Fundamentals of intensive rehabilitation. - M., 1999. - P.76);

There is a known method of treating muscle spasm using post-isometric relaxation, consisting of two phases alternating 5-6 times, first perform an isometric contraction of the muscle while inhaling for 8-10 s, using light resistance provided by the doctor in the direction opposite to the muscle contraction, then passive stretching of the muscle while exhaling for 10-20 s (Belova A.N. Neurorehabilitation. - M.: Antidor, 2000. - P. 115). This method was chosen for the prototype.

However, this method cannot be used to treat severe muscle spasticity, since it is carried out when the muscle performs a contraction phase, which is only possible with mild spasm; contraction of the muscle and retention of this phase for 8-10 s through resistance created by the doctor causes persistent pain in the patient and provokes the subsequent progression of spasticity; with concomitant osteoporosis, with the development of muscle or joint contracture, if the doctor applies more force to stretch the muscle, a limb fracture may occur during the passive stretching phase.

The objective of the invention is to increase the effectiveness of treatment of spastic muscle conditions after a stroke.

The technical result is to reduce muscle spasm and normalize muscle tone.

This is achieved due to the fact that for 20-30 minutes the doctor performs passive stretching of the spasmodic muscle of the limb, combined with rotation of the hand or foot alternately in both directions, with the patient’s forced maximum exhalation, and maintains the stretching phase until the end of exhalation, the exercises are carried out for 3 weeks.

After positioning the patient’s limb in a comfortable position that helps relax the spasmed muscles, the doctor performs a passive exercise, since the patient cannot perform active movements on his own; Considering that the length of the spasmed muscle is sharply shortened, do a stretching exercise that increases the length of the muscle and ensures its reflexive relaxation; turning the hand or foot during the exercise creates the direction of physiological movement of the spasmed muscle according to the biomechanics of movement, promoting its uniform extensibility and restoration of physiological tone; performing the exercise while exhaling creates conditions for reflexive relaxation of the muscle; forced exhalation will allow the patient to exhale as much as possible, which will lengthen the stretching time and allow the muscle to be worked more effectively; maintaining the phase of passive stretching of the muscle while exhaling promotes deeper relaxation and habituation of the muscle to be in a “healthy” state, preventing its subsequent persistent spasm; exercises are performed until a feeling of stretching occurs, relieving the patient of persistent pain and limb injury; the duration of one session of 20-30 minutes allows you to repeat the exercise many times, increasing the angle of extension in the joint of the spastic limb, due to a gradual increase in the length of the muscle and its relaxation; A course of 3 weeks, as practice has shown, will reduce muscle spasm, restore muscle tone, and achieve full movement.

The method of treating muscle spasticity after a stroke is as follows.

The spastic limb is placed in a comfortable position that ensures muscle relaxation, after which for 20-30 minutes the doctor performs passive stretching of the spastic muscle of the limb, combined with rotation of the hand or foot alternately in both directions, with the patient’s forced maximum exhalation, and holds the stretching phase until the end exhalation, exercises are carried out for 3 weeks.

Clinical example.

Patient Zh., I/b No. 22547. Diagnosis: Condition after an acute circulatory disorder in the basin of the right anterior cerebral artery, dated March 22, 2009. Complaints of lack of movement in the left arm, its constant bent position, periodic pain in the left shoulder.

The patient underwent restorative treatment, in which the left arm was placed on a rigid cushion without abduction to the side, providing support from the shoulder joint to the elbow inclusive, which ensured muscle relaxation, after which the doctor performed passive stretching of the spasmodic muscle of the limb, combined with rotation of the hand alternately in both side, on the forced maximum exhalation of the patient while maintaining the stretching phase until the end of exhalation. The exercise was performed daily for 20-30 minutes. The course of treatment was 3 weeks.

As a result of the treatment, the patient experienced a persistent decrease in spasticity of the muscles of the left upper limb, movement in her elbow joint was restored, and at rest she acquired her normal “straightened” position.

A method for treating spastic muscle condition after a stroke by passively stretching the muscle while exhaling, characterized in that for 20-30 minutes the doctor performs passive stretching of the spastic muscle of the limb, combined with rotation of the hand or foot alternately in both directions, with the patient’s forced maximum exhalation, and holds the stretching phase until the end of exhalation, exercises are carried out for 3 weeks.

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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;
clothing that restricts 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 obstacle for the patient, and he is able to lead a normal life, whereas in severe cases the person is forced to move around 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 are able 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.

The connection between the muscles and the brain may be blocked, disrupting their coordinated work. This leads to the fact that muscles prone to flaccidity are stretched (arm extensors, leg flexors), and muscles prone to tension are shortened (arm flexors, leg extensors). This involuntary muscle tension is spasticity after a stroke. She limits your coordination, gait, and normal movements. This Post-stroke conditions make daily activities such as bathing, eating and dressing more difficult.

Spasticity can cause long periods of strong contractions in major muscle groups, causing painful muscle spasms. This may manifest itself as:

Can spasticity be cured?

There are many strategies and treatments for spasticity that can help you recover, return to work, and regain lost function. If you do not get proper treatment, contractures develop, which are very difficult to treat. To achieve better results, it is necessary to use only an integrated approach, including drug and non-drug treatment of spasticity, giving preference to the second.

Spasticity treatment methods:

Medication methods;
Stretching exercises to reduce spasticity;
Specialized differentiated massage;
Electrical stimulation of motor points;
The use of orthoses and splints (together with physical therapy);
Taping;
Transcranial magnetic stimulation;
Surgical methods.

Medicines to treat spasticity:

There are two groups of drugs that can reduce spasticity after a stroke. It is better to start drug therapy with muscle relaxants. If there is no effect, it is necessary to change the drug or add a centrally acting drug. You must remember that the dose must be increased gradually.

Peripheral-acting drugs (muscle relaxants):

Mydocalm (tolperazone) 100-450 mg/day
Sirdalud (tizanidine) 6-36 mg/day
Baclofen 10-100 mg/day

Centrally acting drugs:

non-benzodiazepine tranquilizers (Diazepam, Clonazepam),
anticonvulsants (Finlepsin, Gabapentin, Pregabalin),
alpha adrenergic agonists (Clonidine).

Botulinum toxin(injections into the muscle):

If a stroke patient has a muscle with increased tone without contracture, and pain, muscle spasms, decreased range of motion, and impaired motor function associated with spasticity of this muscle, botulinum toxin type A or botulinum toxin can be used. The clinical effect after injection of botulinum toxin is observed after a few days and lasts for 2-6 months, after which a repeat 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.

Tips for living with spasticity:

Assistive devices and home tools can help reduce the risk of spasticity-related falls. Here Some changes to your home that will improve your safety:

Ramps
Handrails
Raising toilets
Bathroom benches
Rubber mats for the bottom of the bathtub
Braces, canes, walkers, and wheelchairs can help you move freely as you gain strength.