Friday, December 10, 2010

Spasticity & Muscle Spasms

My spinal cord injury is at C-1 C-2 and I am an incomplete quadriplegic. That means I have some connectivity going through my spinal cord from my brain to my body. It also means that I have spasticity and lots of muscle spasms. I have pasted below some information about this and some things that I go through.

Following a spinal cord injury, the nerve cells below the level of injury become disconnected from the brain at the level of injury. This is due to scar tissue which forms in the structure of the damaged area of the spinal cord, blocking messages from below the level of injury reaching the brain. Spasticity does not occur immediately following a spinal cord injury. When an injury occurs to the spinal cord, the body goes into spinal shock, and this may last several weeks. During this time changes take place to the nerve cells which control muscle activity.

Once spinal shock wears off, the natural reflex which is present in everyone reappears. Spasticity is an exaggeration of the normal reflexes that occur when the body is stimulated in certain ways. In an abled bodied person, a stimulus to the skin is sensed, and a sensory signal is sent to the reflex arch where it travels to the brain via the spinal cord, the brain then assesses the stimulant, and if the stimulant is thought not to be dangerous, an inhibitory signal is sent down the spinal cord, and cancels the reflex from moving the muscle.

In a person with a spinal cord injury this inhibitory signal is blocked by the structural damage in the cord, and the natural reflex is allowed to continue resulting in a contraction of the muscle.

I didn't start having spasms until a couple months after my accident. That's also when I started to feel tingling throughout my whole body. The tingling drove me crazy and kept me up at night, so they put me on a medicine to help so I wouldn't feel it. After a while it turned into the feeling I have today, which is pressure in most areas. I can feel the most on the top of my arms.

Muscle spasms can occur in a person with a spinal cord injury any time the body is stimulated below the level of injury. This is usually noticeable when a muscle is stretched, or there is a painful stimulant below the level of injury. Because of the injury to the spinal cord, these sensations can trigger the reflex resulting in the muscle to contract or spasm.

When my arms are lifted in the air it causes a full body spasm. Also, if the water is too hot in the shower my body lets me know by spasming. I cannot feel hot or cold, so the spasms are a good thing.

Almost anything can trigger spasticity. Some things, however, can make spasticity more of a problem. A bladder infection or kidney infection will often cause spasticity to increase a great deal. A skin breakdown will also increase spasms. In a person who does not perform regular range of motion exercises, muscles and joints become less flexible and almost any minor stimulation can cause severe spasticity.

I have not had a bladder infection since April 2009. This is very good for me because I used to get them back to back. I knew I had them because my muscle spasticity would increase a great deal, telling me something was wrong. I do range of motion twice a day to keep my muscles moving and flexible.

Some spasticity may always be present. The best way to manage or reduce excessive spasms is to perform a daily range of motion exercise program. Avoiding situations such as bladder infections, skin breakdowns, or injuries to the feet and legs will also reduce spasticity. There are three primary medications used to treat spasticity, baclofen, Valium, and Dantrium. All have some side effects and do not completely eliminate spasticity.

There are some benefits to spasticity. It can serve as a warning mechanism to identify pain or problems in areas where there is no sensation. Many people know when a urinary tract infection is coming on by the increase in muscle spasms. Spasticity also helps to maintain muscle size and bone strength. It does not replace walking, but it does help to some degree in preventing osteoporosis. Spasticity helps maintain circulation in the legs and can be used to improve certain functional activities such as performing transfers or walking with braces. For these reasons, treatment is usually started only when spasticity interferes with sleep or limits an individual's functional capacity.

Many people with spinal cord injuries don't like muscle spasms, and I used to be one of them. Then I realized that spasms are actually a good thing. Because I'm not moving regularly, they help burn calories. They also help stretch my muscles and change position. My body feels nice and relaxed after a spasm, which helps with my muscle pains in my back and neck. Spasms don't hurt me at all, but I know for some people it can be painful.

A surgical procedure called a radiofrequency rhizotomy is sometimes indicated in the treatment of severe spasticity. Another treatment of severe Spasticity is the implantation of a Baclofen Pump. The pump delivers a programmable amount of baclofen directly to the fluid surrounding the spinal cord. The drug then inhibits the reflex signal in the reflex arch of the cord stopping stimulation of the muscle to spasm. Because the drug is delivered directly to the spinal cord, a very small amount can be used in comparison to a large amount which may have to be taken orally. Once a baclofen pump is implanted, oral anti spasmodic drugs are usually stopped.

I have a baclofen pump surgically inserted. If I didn't have it, I would be spasming constantly and continuously. It is turned up to the highest dose it can be for me, and that the doctor will allow. I'm comfortable with where it's at because I spasm just the right amount, but not too much. I want some rigidity in my muscles for the purposes above.


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1 comment:

Anonymous said...

Jenni, I'm sure that you keep up on medical progress that is being made for people that have experienced spinal injuries. Is there anything on the horizon that is really exciting? You are always in our prayers.