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spasticity
Quix, you said in the Lyme post that spasticity is most likely caused by spinal cord lesions. And spasticity from the brain is terribly disabling.
Since Craig had a normal 3T spine MRI, and his legs have lots of spasticity, how do we know if his spasticity is coming from the brain or spine??
The therapist and physiatrist think it is from the brain simply because of the normal 3T spine, but his muscles are painfully and gradually responding to being stretched. However, the physiatrist said it will be a daily battle to control it. They also figured out that his wide gait is from the outer thigh spasticity and he is able to stand better now.
Does it make a difference to know the cause one way or the other??
thanks,
Elaine
Since Craig had a normal 3T spine MRI, and his legs have lots of spasticity, how do we know if his spasticity is coming from the brain or spine??
The therapist and physiatrist think it is from the brain simply because of the normal 3T spine, but his muscles are painfully and gradually responding to being stretched. However, the physiatrist said it will be a daily battle to control it. They also figured out that his wide gait is from the outer thigh spasticity and he is able to stand better now.
Does it make a difference to know the cause one way or the other??
thanks,
Elaine
Quix - Thanks
I have never had a real neuro exam , just the three min. kind. I do think I would pass your knee test , even though I'm sure I have lost some strength.
My legs "feel' weak , sometimes buckling and I stagger . My sx. are not too bad comparatively . :) I so sorry you and Craig are having such a time of it.
Off subject . I have been using my left hand for everything. In the fall I noticed it and thought , have I always used it this much . Well it continues too increase, while the use of my right hand decreases. I'll be doing something that requires fine motor skills and realize I'm doing it left handed.. without even thinking about it( weird). ??? I was tested for strength and dexterity and the deficit was significant.
Elaine - I'll check into pt. The guy who did the muscle and nerve testing said he'd be happy to work with me . He's very nice and very hunky ( did I say that .. tsk tsk )
I'm so glad to hear Sadie is doing well.
Thanks & Hugs Jo
I have never had a real neuro exam , just the three min. kind. I do think I would pass your knee test , even though I'm sure I have lost some strength.
My legs "feel' weak , sometimes buckling and I stagger . My sx. are not too bad comparatively . :) I so sorry you and Craig are having such a time of it.
Off subject . I have been using my left hand for everything. In the fall I noticed it and thought , have I always used it this much . Well it continues too increase, while the use of my right hand decreases. I'll be doing something that requires fine motor skills and realize I'm doing it left handed.. without even thinking about it( weird). ??? I was tested for strength and dexterity and the deficit was significant.
Elaine - I'll check into pt. The guy who did the muscle and nerve testing said he'd be happy to work with me . He's very nice and very hunky ( did I say that .. tsk tsk )
I'm so glad to hear Sadie is doing well.
Thanks & Hugs Jo
Jo,
The spasticity is in fact, helping Craig to keep upright. I do hope you can get more PT.
Craig goes to a physiatrist (M.D. who specializes in rehab) and his job, he told Craig. is to keep him functioning.
Sadie's mother is a golden Lab, and her father is a goldendoodle (lab and golden retriever mix). She is very gentle and loving...the vet called to say Sadie is still doing well recovering and did eat one tablespoon of food.
Thanks again,
Elaine
The spasticity is in fact, helping Craig to keep upright. I do hope you can get more PT.
Craig goes to a physiatrist (M.D. who specializes in rehab) and his job, he told Craig. is to keep him functioning.
Sadie's mother is a golden Lab, and her father is a goldendoodle (lab and golden retriever mix). She is very gentle and loving...the vet called to say Sadie is still doing well recovering and did eat one tablespoon of food.
Thanks again,
Elaine
Hi, Jo. It sounds like you walk like I do. Question: When you are sitting. Can you lift one knee up and resist against someone pushing down on it? Are the two sides equal?
Craig and I both have major weakness in our hip flexors.
This next thing is part of something I wrote for the Health Pages. It should appear in them in a few days.
SPASTICITY
In certain neurological conditions the muscle tone in certain muscle groups is altered - when it is chronically increased you have a condition known as "spasticity." Spasticity causes an imbalance with the other muscle groups and interferes with smooth and easy movement. One of the concepts you need to understand in understanding spasticity is the existence of opposing muscle groups. For almost every action that muscles do, there is another set of muscles to do the opposite action.
The Example of Bending the Elbow
If you need to use your biceps to flex (bend) your elbow, you contract the biceps, and the brain sends a signal to the triceps to relax and allow the movement. But, to keep the action smooth and controlled, all muscles have a nerve endings called "stretch receptors." In our example of bending the elbow, the triceps relaxes, lenthens and its stretch receptors are activated causing it to pull back on the elbow slightly. This gives you the capability of making very fine movements and of quickly adjusting your motions. If you then want to straighten the arm, you contract your triceps to extend the elbow and make it straight again. The brain commands the triceps to contract and the biceps to relax to allow the arm to straighten. It is always a give and take as you move. All of this happens automatically and generally below your conscious level.
How Spasticity Affects Me
In spasticity the whole thing goes awry. I am going to use my own experience as an example. My first presenting symptom of MS was spasticity in my right leg all the way from my right lower back to my foot. The groups of muscles called the "extensors" had an increased tone in them at all times. Their stretch receptors are always activated causing the extensors to actively contract. The extensors arch the lower back, swing the leg backwards at the hip, straighten the knee, and pull the toes of the foot downward. I found that it took a lot of effort to lift my right foot off the floor when I was standing. Stairs were suddenly difficult. My brain would command the hip "flexors" to bring the knee up, but the signal to relax the hip and leg extensors never happened. They didn't relax, but instead continued to "pull" against my efforts.
As I walked, every stride with the right leg felt as though I had to forcibly drag the leg forward. The simple act of walking became tiring. If I laid on my back to sleep or nap, the increased tone in the right side paraspinal muscles (back extensors) would cause those muscles to keep contracting until they were spasmed into a knot. I learned I had to sleep with my hips bent and began sleeping in my recliner.
I no longer could bend my knee to bring my foot back up toward my buttocks like you do to look at the sole of the foot. The non-stop tone, or spasticity, of the knee extensors (the quads, which work to keep the knee straight) kept me from performing that action.
I also tripped all the time catching my right toe on the floor. I would trip over a simple grout line! It didn't make sense, because I could bend my toes all the way up toward my knee. I should have been able to bring the toes up to clear the floor, but it was hard. When I walked, though, the extensor tone (in my calf) was stronger than my ability to bring up my toes. Because of this my toes pulled down as I walked, constantly tripping me. I had a "functional" foot drop. That is why I was fitted for a brace.
Spasticity is Velocity-Dependent
Spasticity is highly influenced by the speed with which one tries to move. This means that the faster the message is to contract against the tight muscles, the stronger the signal is to keep them rigid. Use the example of the person sitting on an exam table dangling the legs. If the examiner pumps the leg out and back slowly they may feel a little increased resistance over the normal level. But, the faster they pump the leg, the higher the resistance to their attempts. Many of you have seen this in action. You have a leg that often doesn't want to move. It feels like you have a 20# weight on your foot keeping your pace slow. But, you can move. However, if you need to step with that foot fast (say to catch yourself off balance or to dodge a thrown object) the foot is stuck, like it is literally nailed down. That signal to move fast, instantaneously increases the tone in the spastic muscles.
My spasticity was mild. But, as spasticity worsens, movement becomes harder and harder. The muscles become rigid, and the person can no longer overcome the higher tone. As the signal grows to keep the tone up the muscles can became extraordinarily painful and knotted. Eventually the muscle can shorten and "freeze." Finally, the joints can actually become rigidly stiff. They may be straight or twist permanently into unnatural shapes - a condition called "contracture." To prevent permanent shortening and contracture, spastic muscles must be continually stretched multiple times a day. Trained professionals, such as physiatrists and physical therapists are needed to guide this treatment.
Sometimes, spasticity works somewhat to a persons advantage. A common problem that accompanies spasticity is muscle weakness. The muscle doesn't get a clear signal to contract, or some of the fibers get no signal at all, and the muscle shows weakness. If a person has extensor spasticity, this tends to help them maintain an upright posture. If they are unfortunate to have increased tone in the flexors, it can, for example bend them over, bend the knees, and pull the elbows into tight flexion. This is incapacitating and very disabling.
Jo, I hope this description helps. Remember, a person's experience will be different depending on which muslce groups habe the higher tone, the spasticity.
Quix
Craig and I both have major weakness in our hip flexors.
This next thing is part of something I wrote for the Health Pages. It should appear in them in a few days.
SPASTICITY
In certain neurological conditions the muscle tone in certain muscle groups is altered - when it is chronically increased you have a condition known as "spasticity." Spasticity causes an imbalance with the other muscle groups and interferes with smooth and easy movement. One of the concepts you need to understand in understanding spasticity is the existence of opposing muscle groups. For almost every action that muscles do, there is another set of muscles to do the opposite action.
The Example of Bending the Elbow
If you need to use your biceps to flex (bend) your elbow, you contract the biceps, and the brain sends a signal to the triceps to relax and allow the movement. But, to keep the action smooth and controlled, all muscles have a nerve endings called "stretch receptors." In our example of bending the elbow, the triceps relaxes, lenthens and its stretch receptors are activated causing it to pull back on the elbow slightly. This gives you the capability of making very fine movements and of quickly adjusting your motions. If you then want to straighten the arm, you contract your triceps to extend the elbow and make it straight again. The brain commands the triceps to contract and the biceps to relax to allow the arm to straighten. It is always a give and take as you move. All of this happens automatically and generally below your conscious level.
How Spasticity Affects Me
In spasticity the whole thing goes awry. I am going to use my own experience as an example. My first presenting symptom of MS was spasticity in my right leg all the way from my right lower back to my foot. The groups of muscles called the "extensors" had an increased tone in them at all times. Their stretch receptors are always activated causing the extensors to actively contract. The extensors arch the lower back, swing the leg backwards at the hip, straighten the knee, and pull the toes of the foot downward. I found that it took a lot of effort to lift my right foot off the floor when I was standing. Stairs were suddenly difficult. My brain would command the hip "flexors" to bring the knee up, but the signal to relax the hip and leg extensors never happened. They didn't relax, but instead continued to "pull" against my efforts.
As I walked, every stride with the right leg felt as though I had to forcibly drag the leg forward. The simple act of walking became tiring. If I laid on my back to sleep or nap, the increased tone in the right side paraspinal muscles (back extensors) would cause those muscles to keep contracting until they were spasmed into a knot. I learned I had to sleep with my hips bent and began sleeping in my recliner.
I no longer could bend my knee to bring my foot back up toward my buttocks like you do to look at the sole of the foot. The non-stop tone, or spasticity, of the knee extensors (the quads, which work to keep the knee straight) kept me from performing that action.
I also tripped all the time catching my right toe on the floor. I would trip over a simple grout line! It didn't make sense, because I could bend my toes all the way up toward my knee. I should have been able to bring the toes up to clear the floor, but it was hard. When I walked, though, the extensor tone (in my calf) was stronger than my ability to bring up my toes. Because of this my toes pulled down as I walked, constantly tripping me. I had a "functional" foot drop. That is why I was fitted for a brace.
Spasticity is Velocity-Dependent
Spasticity is highly influenced by the speed with which one tries to move. This means that the faster the message is to contract against the tight muscles, the stronger the signal is to keep them rigid. Use the example of the person sitting on an exam table dangling the legs. If the examiner pumps the leg out and back slowly they may feel a little increased resistance over the normal level. But, the faster they pump the leg, the higher the resistance to their attempts. Many of you have seen this in action. You have a leg that often doesn't want to move. It feels like you have a 20# weight on your foot keeping your pace slow. But, you can move. However, if you need to step with that foot fast (say to catch yourself off balance or to dodge a thrown object) the foot is stuck, like it is literally nailed down. That signal to move fast, instantaneously increases the tone in the spastic muscles.
My spasticity was mild. But, as spasticity worsens, movement becomes harder and harder. The muscles become rigid, and the person can no longer overcome the higher tone. As the signal grows to keep the tone up the muscles can became extraordinarily painful and knotted. Eventually the muscle can shorten and "freeze." Finally, the joints can actually become rigidly stiff. They may be straight or twist permanently into unnatural shapes - a condition called "contracture." To prevent permanent shortening and contracture, spastic muscles must be continually stretched multiple times a day. Trained professionals, such as physiatrists and physical therapists are needed to guide this treatment.
Sometimes, spasticity works somewhat to a persons advantage. A common problem that accompanies spasticity is muscle weakness. The muscle doesn't get a clear signal to contract, or some of the fibers get no signal at all, and the muscle shows weakness. If a person has extensor spasticity, this tends to help them maintain an upright posture. If they are unfortunate to have increased tone in the flexors, it can, for example bend them over, bend the knees, and pull the elbows into tight flexion. This is incapacitating and very disabling.
Jo, I hope this description helps. Remember, a person's experience will be different depending on which muslce groups habe the higher tone, the spasticity.
Quix
Elaine
Thanks for the info .
I had pt when this all started . I was walking like I had snow shoes on and had balance problems . I did help . I have been reluctant to ask neuro , but maybe you're right , primary might do it.
How's Sadie , did you get to go see her? What kind is she .. LOVE puppies.. and kittens.
Jo
Thanks for the info .
I had pt when this all started . I was walking like I had snow shoes on and had balance problems . I did help . I have been reluctant to ask neuro , but maybe you're right , primary might do it.
How's Sadie , did you get to go see her? What kind is she .. LOVE puppies.. and kittens.
Jo
Hi Jo,
In Craig's case, he has had a wide gait and his feet are rather far apart. He has had this for about 18 months. The neuros would ask him why he is walking funny, but he didn't know he was walking any differently.
So the physical therapist told him that in MS people lose their balance sometimes because of weak hip flexors and sometimes because of the thigh muscles. Craig's outer thighs feel like rock. The therapist said that if Craig walks with his legs closer together, it will help the muscles to stretch, although it hurts. The therapist and I are also doing lots of stretching exercises for the thighs too.
After the stretching. Craig can actually almost walk normally for awhile.
If you have a PCP that you like, would he/she order physical therapy for you for the stiffness? And yes, stiffness can be spastic muscles. Craig always complained that his legs are stiff and painful.
I hope the 24th is a good appt for you. We'll be waiting to hear!!
Elaine
In Craig's case, he has had a wide gait and his feet are rather far apart. He has had this for about 18 months. The neuros would ask him why he is walking funny, but he didn't know he was walking any differently.
So the physical therapist told him that in MS people lose their balance sometimes because of weak hip flexors and sometimes because of the thigh muscles. Craig's outer thighs feel like rock. The therapist said that if Craig walks with his legs closer together, it will help the muscles to stretch, although it hurts. The therapist and I are also doing lots of stretching exercises for the thighs too.
After the stretching. Craig can actually almost walk normally for awhile.
If you have a PCP that you like, would he/she order physical therapy for you for the stiffness? And yes, stiffness can be spastic muscles. Craig always complained that his legs are stiff and painful.
I hope the 24th is a good appt for you. We'll be waiting to hear!!
Elaine
Elaine
I'm glad you have brought this up again. I have a gait problem and don't know if it is spacitity. I don't know the difference between it and stiffness. I may have mentioned before it seems to come from my hips, no pain( well not exactly, I have pain but that shouldn't hamper my gait like this ). And I'm off balance
I walk kind of stiff, not fluid. I think to myself , you should be able to do this and try to reason it into being . It just doesn't happen. And if someone is watching me , it feels even worse , maybe because I'm so self conscious of it . It makes me feel bad or sad for some reason??
Can any one help with how to tell the diff. ? I guess it could be old age ! :)
My neuro has refused to do a t-spine mri or give me a ssep. So I don't know the whole story. He will hopefully be out of my life soon . Second opinion the 24th
I was stunned when you told us what Dr. M did and said to Craig . I think it hurt all of us to hear that he had been so hateful. Craig is a fortunate man to have you in his life .
You all take care jo
I'm glad you have brought this up again. I have a gait problem and don't know if it is spacitity. I don't know the difference between it and stiffness. I may have mentioned before it seems to come from my hips, no pain( well not exactly, I have pain but that shouldn't hamper my gait like this ). And I'm off balance
I walk kind of stiff, not fluid. I think to myself , you should be able to do this and try to reason it into being . It just doesn't happen. And if someone is watching me , it feels even worse , maybe because I'm so self conscious of it . It makes me feel bad or sad for some reason??
Can any one help with how to tell the diff. ? I guess it could be old age ! :)
My neuro has refused to do a t-spine mri or give me a ssep. So I don't know the whole story. He will hopefully be out of my life soon . Second opinion the 24th
I was stunned when you told us what Dr. M did and said to Craig . I think it hurt all of us to hear that he had been so hateful. Craig is a fortunate man to have you in his life .
You all take care jo
IF YOU DON'T MIND I'M GOING TO JUMP IN HERE.I HAVE TERRIBLE SPACTICITY,A COMBINATION OF THE MS AND ARACHNOIDITIS.
I TRY TO STRETCH DAILY,ELAINE I WEAR A KAFO ON THE RIGHT LEG TO KEEP THE GAIT AS NORMAL AS CAN BE.MY STRENGTH TEST IN MY LEGS WAS A 2/5.
WOULD A KAFO HELP CRAIG WITH HIS GAIT,IT SURE HELPS ME WITH MY WALKING.
ALSO I'M ON A COMBINATION OF SPASMATICE MEDS THAT DO HELP A GREAT DEAL WITH THE SPASMS.MY NEURO HAS WENT BACK TO THE OLD SCHOOL OF MEDICINE (POLYPHARMACY) AND HAS PRESCRIBED A COCKTAIL OF BACLOFEN,ZANAFLEX AND VALIUM.
WE TRIED THIS BEFORE AND WHEN WE THOUGHT THINGS WERE GOING WELL WE WENT BACK TO JUST THE BACLOFEN,NEEDLESS TO SAY AFTER A FEW MONTHS WE HAD TO GO BACK TO THE COMBINATION OF THE 3 MEDS.
I HAVE A LESION IN MY BRAIN STEM,NOT DETECTED BY THE MRI,BUT A VNG FROM THE NEURO-OTOLOGIST.
CRAIG IS IN MY PRAYERS DAILY,I SURELY PRAY THEY GET ANSWERS SOON.
ELAINE,I THINK YOUR AWESOME,CRAIG IS A VERY LUCKY GENTLEMAN TO HAVE YOU.WHEN FIGHTING ANY ILLNESS,IT TAKES THE WHOLE FAMILY.
HAS CRAIG HAD A SSEP? THIS COULD HELP IN DETECTING AN ABNORMALITIES IN THE SPINE TO THE BRAIN THAT THE MRI DIDN'T PICK UP.
JUST SOME THOUGHTS.
HUGS TO BOTH
T-LYNN
I TRY TO STRETCH DAILY,ELAINE I WEAR A KAFO ON THE RIGHT LEG TO KEEP THE GAIT AS NORMAL AS CAN BE.MY STRENGTH TEST IN MY LEGS WAS A 2/5.
WOULD A KAFO HELP CRAIG WITH HIS GAIT,IT SURE HELPS ME WITH MY WALKING.
ALSO I'M ON A COMBINATION OF SPASMATICE MEDS THAT DO HELP A GREAT DEAL WITH THE SPASMS.MY NEURO HAS WENT BACK TO THE OLD SCHOOL OF MEDICINE (POLYPHARMACY) AND HAS PRESCRIBED A COCKTAIL OF BACLOFEN,ZANAFLEX AND VALIUM.
WE TRIED THIS BEFORE AND WHEN WE THOUGHT THINGS WERE GOING WELL WE WENT BACK TO JUST THE BACLOFEN,NEEDLESS TO SAY AFTER A FEW MONTHS WE HAD TO GO BACK TO THE COMBINATION OF THE 3 MEDS.
I HAVE A LESION IN MY BRAIN STEM,NOT DETECTED BY THE MRI,BUT A VNG FROM THE NEURO-OTOLOGIST.
CRAIG IS IN MY PRAYERS DAILY,I SURELY PRAY THEY GET ANSWERS SOON.
ELAINE,I THINK YOUR AWESOME,CRAIG IS A VERY LUCKY GENTLEMAN TO HAVE YOU.WHEN FIGHTING ANY ILLNESS,IT TAKES THE WHOLE FAMILY.
HAS CRAIG HAD A SSEP? THIS COULD HELP IN DETECTING AN ABNORMALITIES IN THE SPINE TO THE BRAIN THAT THE MRI DIDN'T PICK UP.
JUST SOME THOUGHTS.
HUGS TO BOTH
T-LYNN
I can't remember the source for that info. But, it made a lot of sense at the time. The spasticity of cerebral palsy, which is a diffuse brain injury, typically involves most of the body, limbs, trunk and face and is horribly disabling, preventing most effective movement. In MS, usually the spasticity is limited in location,opne or both legs, one side, one or both arms. This makes ambulation difficult, but does not preclude it, until later in the disease.
There is no difference in how it is treated. You use a combo of stretching, muscle relaxant meds, and antispasmodics + whatever else works.
I can't back up my comment with a cite until I find that source again, but it is one of the things I have my attention out for. A lot of people have asked which symptoms are spinal and which are brain, and I am still sorting it out and learning.
Thinking about Craig's situation may contradict what I said, so maybe what I read was wrong. For his purposes I would believe the doctors that are seeing him and treating him. ((Except for Dr. M who says there is nothing wrong with his legs. (?????)) Then again, we know I have a lesion on my brainstem that caused the TN, and it didn't show up on either 3T MRI. So that throws us back to "all lesions are not visible."
I don't know, I guess, I give up.
Quix
There is no difference in how it is treated. You use a combo of stretching, muscle relaxant meds, and antispasmodics + whatever else works.
I can't back up my comment with a cite until I find that source again, but it is one of the things I have my attention out for. A lot of people have asked which symptoms are spinal and which are brain, and I am still sorting it out and learning.
Thinking about Craig's situation may contradict what I said, so maybe what I read was wrong. For his purposes I would believe the doctors that are seeing him and treating him. ((Except for Dr. M who says there is nothing wrong with his legs. (?????)) Then again, we know I have a lesion on my brainstem that caused the TN, and it didn't show up on either 3T MRI. So that throws us back to "all lesions are not visible."
I don't know, I guess, I give up.
Quix
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