Treatment of Long Term TBI-Related Spasticity
Inability to Relax Muscles a Symptom of Traumatic Brain Injury (TBI)
Oct 7, 2009
Spasticity describes the condition that results when a person with acquired traumatic brain injury or TBI cannot voluntarily relax a limb. The interruption of message flow along nerve pathways can cause changes in muscle tone, movement, sensation and reflex. The location of the TBI determines the part of the body that is affected.
Spasticity may be noticed soon after a head injury that is due to an automobile accident, sports injury, explosion or other incident that results in an open or closed head wound. But it may not be obvious for six months. In some cases, especially when caregivers need to respond to the treatment of life-threatening medical conditions, the onset will go unnoticed and untreated until it is too late.
Early Diagnosis of Spasticity Enables Treatment with Physical Therapy
If noticed soon after the brain injury, the muscle can be stretched to limit permanent shortening of the muscle. If therapy is not used, joint movement will be inhibited permanently. Therefore, early TBI caregivers should look for signs of spasticity such as toe pointing and finger curling.
If the TBI sufferer is in a coma, family should be especially alert for signs of unreleased and contracting muscles. According to the Brain Injury Research Foundation, a patient should be receiving physical therapy immediately after acquiring a brain injury in order to stretch muscles and move joints. Splits and casts may be used to hold the abnormally contracting muscle in the elongated position.
Even in cases of moderate to severe TBI where more immediate medical attention is also required, spasticity issues should not be overlooked since the loss of control and motion can be an impediment to physical appearance and activity later in life.
Long Term Spasticity is Irreparable
Normally, the brain controls muscle movement. Brain injury causes a change in the balance of signals between the nervous system and the muscles. Reflexes may become overactive. Ultimately, the condition leads to paralysis.
If not treated with physical therapy early, the damage becomes irreparable. Day to day symptoms, including lack of control and pain, interfere with daily functioning or with sleep.These symptoms, can only be relieved with medications.
Treatment of the Long Term Symptoms of Spasticity
Oral medications including Baclofen, Benzodiazepines, Dantrolene sodium, Imidazolines, and Gabapentin are currently used, though none completely control spasticity. They can make TBI sufferers sleepy, and cannot be tolerated on an ongoing basis.
The patient may receive anesthetic, alcohol, and botulinum toxin (Botox ®) injections directly into the effected nerves and muscles to produce a better level of function. The injections act as blocks to temporarily paralyze nerves and muscles. Anesthetics last for a few hours and alcohol and botulinum toxin lasts 3 to 6 months.
Medication management may require the use of two or more of these in combination. As a last resort, orthopedic surgery to lengthen or transfer tendons may also be recommended in some patients.
More about Botulinum Toxin (BTA) or Botox Injections
The brand name medication Botox, widely known for its cosmetic use, is frequently used today for for a variety of neurological disorders from writer’s cramp to cerebral palsy. When Botox is injected into the muscle, the release of acetylcholine, a neurotransmitter, is blocked and the muscle cannot contract when the muscle belly relaxes. The injection general takes effect within a few days and last three to four months, until new nerve endings grow and the affected muscle at the injection site recovers.
The botulinum toxin is produced by a bacterium that normally lives in the soil. It is quite lethal and must be diluted for safe injection. The medication is packaged in doses far below amounts that could cause serious harm.
Range of Long Term TBI-related Spasticity Symptoms
Symptoms may be as mild as simple muscle tightness or as severe as painful and uncontrollable spasms of the legs and arms. Spasticity may also cause feelings of pain or tightness in and around joints and low back pain.
Stiff muscles cause movements to be imprecise and make some tasks difficult. Muscle spasms can be uncontrollable and painful, lead to deformities, and result in muscle fatigue. Pressure sores and systemic illnesses are additional complications that may result from spasticity.
The right treatment must be evaluated on a case-by-case basis and depends on additional factors such as age. The goal of long term treatment of spasticity related to TBI is to relieve pain due to contractions, improve muscle control, and improve daily living and ease of care.
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