2004 suplement 2

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Volume 13, suplement 2

Interdisciplinary problems of spasticity

Neurorehabilitation in spasticity

KARL-HEINZ MAURITZ1
1. Klinik Berlin and Charité – Berlin University Medical School
Postępy Psychiatrii i Neurologii, 2004, suplement 2 (18), 41-47
Keywords: spasticity, neurorehabilitation

Abstract

Aim. There are different therapeutic approaches to the neurorehabilitation of spasticity which will be addressed in this paper.

Review. The term "spasticity" is used for velocity-dependent muscle tone increase, but also for enhanced ten don reflexes with positive Babinski's sign, exaggerated cutaneous and autonomic reflexes, involuntary flexor and extensor spasms, clonus, impaired movement execution, enhanced muscular resistance against passive movement, abnormal limb postures, clumsiness, enhanced fatigability and paresis. The definition of the term spasticity has changed in the last decades. First it referred only to the velocity-dependent increase in muscle tone, more recently all the above-mentioned phenomena are summarized as the upper motor neurone syndrome. These different definitions serve not an academic purpose but are of practical importance. Most pharmacological studies dealing with drug treatment of spasticity use stretch reflex excitability and/or clonus intensity as parameters to assess the efficacy of antispastic treatment. Velocity-dependent muscle tone and enhanced stretch reflexes have only little functional significance for the patient as the intensity of stretch reflex responses and of clonus hardly corresponds to the quality of movement execution. Dyssynergic patterns of muscle activation with co-activation of agonists and antagonists, paresis and loss of dexterity together with fatigability are much more important for the functional outcome. Increased muscle tone has a potential value. Extensor hypertonicity can provide the rigidity for weight-bearing stance. Spasticity should be treated however if it interferes with nursing, contributes to contractures, causes painful spasms or hampers movements.

Conclusions. The first step is to exclude any noxious and enhancing stimulus like urinary tract infections, pain, bowel and bladder distensions, pressure sores etc. Physiotherapy, physical stimuli (ice, electrical stimulation), pharmacotherapy, chemical blocks or neurosurgical interventions should be selected or combined according to the individual status of the patient.

Address for correspondence:
Prof. Karl-Heinz Mauritz, Kladower Damm 223, D-l 4089 Berlin, Germany, e-mail: mauritz@berlin.snafu.de