內容目錄
muscle cramps Strong>, refers to the phenomenon of sudden and involuntary muscle contractions. Muscle spasms that occur in the calf and toes are the most common. When the attack occurs, the muscles are stiff and painful, which can last for a few seconds to tens of seconds. “Cramping is not a disease, it hurts really bad. Have you ever experienced it, let’s see what’s going on with muscle cramps in recovery?
Lance (1980) defined spasticity as: It is a movement disorder characterized by increased speed-dependent muscle tone due to increased excitability of stretch reflexes, and is accompanied by hypertensive tendon reflexes.” The so-called stretch reflex refers to When the skeletal muscle is stretched by external force, it can reflexively cause the stretched muscle to contract. The mechanism is that the stretching excites the muscle spindle and causes the extrafusicular muscle to contract through the γ loop.
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Spasm is not just a movement disorder, it is often accompanied by sensory abnormalities, such as pain in the spastic limbs, abnormal sensitivity to temperature, etc. Therefore, < strong>Pandyan in 2005 redefines spasticity as: Spasticity is a disorder of sensorimotor control caused by damage to upper motor neurons, characterized by intermittent or continuous involuntary muscle activation.
spasticity)Commonly known as cramps:It is caused by hyperreflexia of the spinal cord and brain stem after upper motor neuron (UMN) injury A state of abnormally increased muscle tone. Spasms often occur after lesions of the brain or spinal cord,but not all increases in muscle tone are called muscle spasms.
contracture|| refers to the limited passive range of motion of the joint caused by lesions of the joint itself, muscles and soft tissues. Contractures are common in bone, joint and muscular system injuries, various types of nerve paralysis, long-term bedridden, wheelchair-bound patients, etc., and are different from spasticity.
a certain muscle tone to maintain body position and limbs However, excessive muscle tension restricts the movement of limbs, affects activities of daily living, and is not conducive to patient care and rehabilitation training. Such as spasticity accompanied by pain also affects the patient’s sleep, mood and mental state . Signs of spasticity also include jackknife phenomenon, hyperreflexia, positive Babinski sign, and flexor spasm.
Classification of Muscle Spasms
Spasms are common in diseases of the central nervous system, such as children with cerebral palsy, stroke, traumatic brain injury, spinal cord injury, multiple sclerosis, etc. It can be divided into:
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①brain-derived spasm: such as spasticity caused by stroke, traumatic brain injury and cerebral palsy;
② Spinal spasm: according to the degree of spinal cord injury, it is divided into two categories: complete spasm and incomplete spasticity;
③Mixed spasticity : such as spasticity caused by multiple sclerosis.
Pathophysiological mechanisms
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(1) Enhanced motor neuron excitability: Including the enhancement of excitatory input, segmental input (segmental afferents ), increased excitability of interneurons (locally) as well as increased excitability of descending pathways (vestibular tract).
(2)Stretch-induced enhancement of motor neuron synaptic excitability:If excitatory interneurons are more sensitive to afferents from muscle pulling, the excitation threshold (threshold) decreases (lower than normal stimulation) and gain (gain) increases Large (threshold does not change, reflection intensity increases).
(3) Decreased input to inhibitory synapses: such as the recruitment of Renshaw cells (recruitment) was inhibited, and the excitability of la inhibitory interneurons was reduced or the afferents of lb fibers were reduced.
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In a nutshell, when the upper motor neurons are damaged, the regulation of the stretch reflex of the spinal cord by the superior center occurs Obstacles, such as decreased central inhibition and/or increased excitability, resulting in increased excitability of the stretch reflex “last common pathway”a motor neuron , eventually leading to hypersensitivity to stretch reflexes and overreaction, manifested as involuntary strong or strong muscle contractions, showing varying degrees of resistance to passive stretch, that is, spasticity.
Rehabilitation Assessment
Clinical evaluation of spasticity can not only understand the severity of spasticity, but also compare the therapeutic effects of spasticity, which is beneficial to the formulation of treatment plans. Among them, there are scales and instrument evaluations, and scales are more commonly used in clinical practice.Especially. Ashworth scale for spasticity (ASS) and modified Ashworth scale (MAS) are most commonly used.
Rehabilitation ScaleAssessment< /strong>
1. Ashworth Spasticity Scale and Modified Ashworth Scale, which are currently The most widely used spasticity rating scale in clinic, with good validity and reliability. Both scales classified muscle tone into 0-4 grades, which changed the assessment of spasticity from qualitative to quantitative. The difference between the two is that the modified Ashworth scale is more subdivided than the Ashworth Spasticity Scale.The former adds a grade of 1+ between grades 1 and 2, while the others Exactly the same.
Modified Ashworth Spasticity Scale
if no if no , the Ashworth Spasticity Scale (ASS)
In recent years, some foreign scholars believe that, The Ashworth Spasticity Scale and the Modified Ashworth Scale only assess muscle tone, ignoring tendon reflexes and clonus, which are closely related to spasticity, so they are not comprehensive. According to reports in the literature, the reliability of these two scales in assessing spasticity of the upper extremity is better than that of the lower extremity.
2. Composite spasticity scale (CSS), < /strong>It includes three aspects, namely tendon reflexes, muscle tone and clonus. Currently, it is mainly used in the assessment of lower extremity spasticity after brain injury and spinal cord injury. The scale has good validity and high reliability.
3. Bilateral adductor muscle tone grading(bilateral adductortone rating) This rating is a specific scale for evaluating the adductor muscle group of the hip. It is mainly used to evaluate the changes of muscle tension before and after treatment in patients with adductor spasm. Including 0~4 levels.
Bilateral adductor muscle tone grading
4. Spasm frequency scale（spasm frequency scale） and spastic clonus score（clonusscore）, etc. .
Instrumental Assessment
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General instrument evaluation requires instruments and requires high clinical experience of examiners, and is not mature enough, so its clinical practicability is limited , so it is less clinically used
1. Electrogram (EMG) examination, analysis of its H reflex, F wave, Hmax/Mmax
, etc.
3. Gait analysis （gait analysis） is a multi-channel dynamic EMG technology Applications in the walking and gait cycle.
Functional Rating
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Spasticity often affects the patient’s functional activities to varying degrees.Therefore, it is necessary to evaluate the movement of patients with spasticity Functions such as bed movement, postural transfer, balance and gait, and activities of daily living (ADL)reasoning ability, etc.
spasm often affects the patient’s functional activity Therefore, for patients with spasticity, it is necessary to evaluate their motor functions such as bed activities, postural transfer, balance ability and gait, as well as activities of daily living (ADL) self-care ability. The application of manual muscle strength test, measurement of joint range of motion (ROM), Brunnstrom motor function, Fugl-Meyer scale, Barthel index (BI) or functional independence assessment (FIM), Berg balance scale, Holden walking function classification (FAC), gait analysis, etc., to comprehensively understand the impact of spasticity on various aspects of functional activity.
Rehabilitation for Muscle Spasms strong>
In clinical practice, spasticity alone cannot determine treatment, Whether to treat spasticity and how to actively implement effective measures should be guided by the patient’s functional status. Antispasmodic therapy aimed at lowering muscle tone is only required when exercise capacity, body positioning, care or comfort are affected to a certain extent by spasticity. Rehabilitation treatment methods include common physical therapy, occupational therapy, psychotherapy, and the use of rehabilitation engineering orthoses.
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Treatment goals for spasticity: Include improvements in mobility, ADL, personal Hygiene; reduce pain and spasm; increase the range of motion of the joints and expand the range of motion of the joints; increase the appropriateness of the orthosis to wear, improve the orthopedic position, and improve the endurance; Comfort; eliminates harmful irritants, prevents pressure ulcers or promotes faster healing and makes nursing easier; prevents or mitigates complications related to dystonia such as contractures, delays or avoids surgery; ultimately improves patients and their care quality of life of the people.
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1. Eliminate predisposing factors that exacerbate spasticity
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Convulsions can be induced by a variety of causes, especially in patients who are comatose, cognitively impaired, and have difficulty communicating. Common causes include urinary retention or infection, severe constipation, and skin irritation (eg, pressure ulcers or increased external sensory stimuli such as improper braces and urine bags). Sometimes worsening of the spasticity signifies a potential acute abdomen and lower extremity fractures, especially in patients who cannot accurately articulate their pain and who cannot identify their discomfort. These triggers should be eliminated first.
2. Correct body position and sitting position
(1) Correct body position: Keep the limbs in good condition against spasm Posture, called good posture, can prevent cramps. If spasticity has already occurred, a good antispasmodic position can also relieve spasm, and various positions that can aggravate spasm should be avoided.
(2) Correct sitting posture: The basic principle of sitting posture is that the body can be maintained in a balanced, symmetrical and stable position. Comfort and maximum functionality. The ultimate goal of different types of sitting systems is to keep the pelvis stable, not tilted, and slightly forward, so that the spine can maintain lumbar, thoracic and cervical flexion. The spinal cord is usually maintained at 90°, and the knee and ankle are usually 90° °. Patients with severe spasticity require a series of modifications in sitting devices such as foot straps, knee pads, adduction rings, and lumbar support in order to maintain this position.
3. Physiotherapy
Physical therapy methods includeneurodevelopmental techniques, manual therapy, exercise rehabilitation Learning method, functional activity training and physical factor therapy, etc., the main role is to relieve spasticity and the pain caused by it, prevent joint contracture deformation, improve the patient’s exercise ability, Thereby improving the quality of life of patients with spasticity as much as possible.
(1) Neuromuscular stimulation technology: Mainly based on the normal neurophysiological and developmental process of the human body, using a variety of sensory stimuli, using induction or inhibition methods, so that patients gradually learn how to control limb spasms, in a normal way of movement to complete daily activities. . Such as Bobath technology, Bunnstrom technology, Rood technology, PNF technology.
width=”600″> >Brunnstrom’s 6 Stages of Recovery After Brain Injury
< span>(2) Manual therapy: At present, it is believed that manual stretching on the joints of spastic limbs can relieve muscle spasm and improve the range of motion of joints. The strength should be slowly increased during manual stretching. When you feel the resistance of soft tissues such as muscles, hold this position for at least 15 seconds, then relax and repeat. There is no consensus on how long a spastic muscle should be stretched for, but it is generally believed that at least 2 hours every 24 hours should allow the muscle to remain fully stretched.
(3) Exercise re-learning:< /strong>This method is mainly used for stroke patients, and can also be used for patients with other movement disorders. This method selects any part of the 7 aspects (upper extremity function, orofacial function, bedside sitting, sitting balance, standing and sitting, standing balance, walking) according to the analysis to design training content, but to eliminate the inconvenience necessary muscle activity.
4. Occupational Therapy and Psychotherapy To perform bed activities, postural transfer, balance ability and gait, as well as activities of daily living (ADL) self-care ability for patients. Improve patients’ ADL competencies, family participation and social participation. Psychotherapy mainly includes health education and rehabilitation psychological guidance for patients, allowing patients to match and treat, and recover as soon as possible.
5. Production and Application of Orthotics
Orthosis making is one of the important treatments in spastic rehabilitation. In the case of muscle spasm, orthoses can relieve muscle spasm, pain, prevent and/or correct deformity to a certain extent through continuous stretching of muscles and fixation of bones and joints., to prevent joint contractures and promote the establishment of normal movement patterns. A wide variety of orthoses are now available to hold spastic limbs in a resting or functional position, minimizing the risk of contractures. Such as ankle-foot orthoses (AFOs), which are effective in correcting plantar flexion and varus of the foot.