Spasticity is a condition in which certain muscles are continuously contracted. This contraction causes stiffness or tightness of the muscles and may interfere with movement, speech, and manner of walking. Spasticity is usually caused by damage to the portion of the brain or spinal cord that controls voluntary movement. It may occur in association with spinal cord injury, multiple sclerosis, cerebral palsy, damage to the brain because of lack of oxygen, brain trauma, severe head injury, and metabolic diseases such as adrenoleukodystrophy, amyotrophic lateral sclerosis (Lou Gehrig's disease), and phenylketonuria. Symptoms may include hypertonicity (increased muscle tone), clonus (a series of rapid muscle contractions), exaggerated deep tendon reflexes, muscle spasms, scissoring (involuntary crossing of the legs), and fixed joints. The degree of spasticity varies from mild muscle stiffness to severe, painful, and uncontrollable muscle spasms. Spasticity can interfere with rehabilitation in patients with certain disorders, and often interferes with daily activities.
When I first heard the term "spasticity," I thought its meaning was similar to spasm. I've since learned the correct synonym is "stiffening," and when used to describe a shoulder can be called "frozen."
Today's educational moment is brought to you by my very own stiffening shoulder. I'm sure I've mentioned in earlier posts that the range of motion in my right shoulder is decreasing. Little things like lifting my arm to turn on the car radio, or reaching in to get something out of the refrigerator, or taking a dish out of the microwave are becoming very, very difficult. I see Mike twice a week and he works on trying to loosen my shoulder and increase my range of motion, using massage and whole arm movements. Sometimes, early in the session, these activities are incredibly painful. I grit my teeth and use breathing techniques to work through the initial pain. By the end of the session, I feel okay.
Mike is concerned about how much range I've lost. He stresses the importance of my doing my "homework." I do it, but it hurts like hell. Let me describe for you what I do; you do it, too, so you can appreciate what I must go through.
In a standing position, place the back of your right hand against the small of your back. Make sure you are standing straight. How does that feel? Probably not bad at all. Well, I can't do it unless I'm bent over. Anyway, now gently squeeze your shoulders back. How does that feel? I used to like how that felt. I don't anymore because it hurts too much. Finally, slide your hand just slightly up toward the middle of your back. Well? Can you guess how I feel when I do that? I'll have you know it doesn't hurt at all -- because I can't move my hand that far. Okay, exercise over.
I find it interesting to note the change, considering I was able to do this not very long ago. Spasticity is part of the disease; I knew on one level it would happen but I am amazed on another level that it did.
The worst part is the slow, creeping loss of ability. It doesn't happen overnight -- it happens gradually, and one day you realize that you are changed.
Several PALS use baclofen, either in pill form or via a pump, to help with spasticity. During my next clinic (in March) I will mention it to Dr. Bayat. As an aside, let me tell you I've read of another ALS patient who, after having the baclofen pump installed, actually experienced improvement. You never know.
On another note, Cecilia told me they are studying genetic diseases in her science class, and that one of the diseases listed was ALS. I reminded her that only 5-10% of all ALS cases are familial; the remainder are sporadic.
Time to do my homework. Have a super weekend.
