Stroke is a condition that occurs when the blood supply to the brain is cut off due to a blockage or rupture of a blood vessel. Symptoms that may occur as a result of a stroke, such as:
- Speech becomes unclear or chaotic, even unable to speak at all
- The eyes and mouth look down on one side of the face
- Reduced hand and leg strength
- Stiff hands (spastic)
The recovery period for stroke patients is very important, especially to prevent defects or deficiencies that may arise after a stroke. However, it takes quite a long time to recover to its original state. Therefore one of the things that can be done is physiotherapy. This is intended so that neurological function can return to normal or minimize defects that may occur. Relative physical recovery time, this depends on each person. Physiotherapy performed can last several months or even years. Usually therapy will be stopped if the patient's condition no longer shows progress.
The discussion this time is about spasticity in the hands, which is one of the consequences of a stroke. In spasticity, the muscles feel tense, making it difficult for the muscles to move. This interferes with activity. For example, spasticity in the biceps causes the elbow to be in a bent position, making it difficult for the patient to straighten the elbow to pick up objects or shake hands. Spasticity generally appears within a few months after a stroke. Find out more information about spasticity through the reviews below.
What is Spasticity?
Spasticity is a condition in which the muscles are unconsciously contracting continuously, so that the muscles are stiff, tense , there is resistance when moved , and inflexible.
During a stroke, the condition of the arms, legs or even the face will experience paralysis.
Often, post-stroke spasticity makes sufferers feel that they are moving very slowly or as if they are carrying a heavy load on their muscles.
In fact, the muscles will hurt when they are resting or when they are moved. Of course, this condition will make the sufferer uncomfortable. If you pay attention, it appears that the muscles are in an unusual position or are bent at rest.
How common is this condition?
The American Stroke Association states that around 25-43% of stroke patients will experience spasticity in the first year after stroke. Not all stroke patients will experience spasticity.
Post-stroke spasticity is more common in young stroke survivors caused by bleeding. This condition occurs within a few months after the attack.
Problems due to Spasticity:
- Difficulty dressing: with a spastic elbow in a flexed position the patient generally has difficulty putting on pants or shirts.
- It's hard to take care of yourself: for example when taking a shower, washing/combing your hair, or even eating alone, because it's hard to straighten your elbows.
- Difficulty picking up/holding things
Causes of spasticity
In a stroke, the area of the brain that controls (brakes) muscle contractions is damaged, so there is no inhibition (brakes) for muscle contractions. As a result, the muscles contract continuously.
Spasticity does not only occur in strokes. Accidental brain injury, cervical spine injury, cerebral palsy, brain tumors and multiple sclerosis are other causes of spasticity.
Spasticity management
Spasticity must be treated in a multidisciplinary manner. No one therapeutic modality is superior to another.
- Physical and occupational therapy
This therapy is mandatory for all stroke patients, with or without spasticity.
Usually, the therapist will recommend regular exercises to stretch and strengthen your muscles.
The therapist may suggest wearing a cast or brace to help stretch muscles that are tight after a stroke.
Meanwhile, electrical stimulation may also be needed, especially if you have contractures.
- Medicines and botulinum toxin injections
The following are some medications that may be recommended to reduce spasticity symptoms.
- Baclofen
- Benzodiazepines
- Dantrolene sodium
- Imidazoline
- Gabapentin
Botulinum toxin injections can also be used to relax sore muscles . This toxin is injected into a spastic muscle. Botulinum toxin injections are quite effective in reducing spasticity. However, this toxin must be injected repeatedly (4-6 months).
- Operation
There are several procedures that can be performed for patients with post-stroke spasticity. These procedures aim to: 1. Reduce spasticity itself, 2. Stretch joints that have contracted, 3. Stabilize bones/joints that are deformed due to spasticity and contractures.
Operations on spastic hands are carried out at least 1 year after a stroke, because in the first 1 year there are still improvements that can occur. Surgery generally produces results that are sustainable in the long term.
Article written by dr. Margareta Arianni, Sp.OT (K) Hand Surgery (Orthopedic & Traumatology Specialist, Hand Surgery Consultant at EMC Alam Sutera Hospital).