special subjects
Stroke Rehabilitation
Spasticity
In some stroke patients, spasticity develops. Spasticity is an increased, involuntary, velocity-dependent muscle tone that causes resistance to movement Spasticity reference . Spasticity may be painful and debilitating. Slightly spastic knee extensors can lock the knee during standing or cause hyperextension (genu recurvatum), which may require a knee brace with an extension stop. Resistance applied to spastic plantar flexors causes ankle clonus; a short leg brace without a spring mechanism minimizes this problem. Flexor spasticity develops in most hemiplegic hands and wrists. Unless patients with flexor spasticity do range-of-motion exercises several times a day, flexion contracture may develop rapidly, resulting in pain and difficulty maintaining personal hygiene. Patients and caregivers are taught to do these exercises, which are strongly encouraged. A hand or wrist splint may also be useful, particularly at night. One that is easy to apply and clean is best. Heat or cold therapy can temporarily decrease spasticity and allow the muscle to be stretched. Patients with hemiplegia may be given benzodiazepines to minimize apprehension and anxiety, particularly during the initial stage of rehabilitation, but not to reduce spasticity. However, benzodiazepine should not be used for long-term therapy for reducing spasticity. Medications such asbaclofenandtizanidinecan be used for modulation of spasticity. Local injections of botulinum toxin and chemodenervation withphenolinjections are often used to help control spasticity and prevent contractures. 