This was when I first started researching on it in 2006, still no answers.
Sorry about ranting on spasticity. I guess if I look at it objectively I have a mild form, it is just that if I was truly paralyzed and only had to recover function instead of suppressing spasticity/tone first and then work on the paralyzed muscle it would be much easier. I have done both baclofen and zanaflex which didn't help the spasticity at all, just made me tired so I quit them. I have had several rounds of botox which helped with knocking out my bicep so my tricep could start working. Finger flexors were also knocked out but since my finger extensors need to move control to a different spot in my brain that didn't result in any improvement.
This was one of my early posts on lots of stroke forums. No one responded with any decent information
Found an interesting site Movement Disorder Virtual University that has lots of detail on spasticity. Here is the link http://www.mdvu.org/library/disease/spasticity/spa_mpath.asp
If you follow it down quite a few levels you can find this
Subject: Incidence and Consequences of Spasticity After Stroke
Date: 2/20/2004
Spasticity affects less than one quarter of stroke victims, according to this study.
Muscle overactivity and its consequences were assessed in 95 patients both immediately after and three months a first-time stroke. Seventy-seven (81%) were initially hemiparetic, of whom 20 had spasticity. Among these 20 patients, 14 had hyperreflexia. Within these patients, 3 had clonus, and 3 had muscle stiffness. Modified Ashworth score was grade 1 in 10 patients, grade 1+ in 7, and grade 2 in 3. None had grades of 3 or 4. At three months, 64 patients (67%) were hemiparetic, and 18 spastic, reflecting 5 whose tone normalized and 3 who became spastic in the interim. The correlation between muscle tone and a range of motor and activity scores was low for most measures at both time points, except for active movements initially, and rapid movement scores and 9-Hole Peg Test scores at three months.
The authors conclude, “spasticity seems to contribute to motor impairments and activity limitations and may be a severe problem for some patients after stroke,” but, given the relatively low numbers of patients with spasticity, they note, “Our findings support the opinion…that the focus on spasticity in stroke rehabilitation is out of step with its clinical importance.
Basically since only 25% of stroke survivors have it and most seem to be able to do ADL's, clinical research seems unlikely. So we are on our own unless we can somehow change that mindset.
As a final comment, my ADL's are just fine. If I can get past the spasticity I can start doing all the normal stuff I did pre-stroke which is why I am extremely interested in this.
This study is from 2004. More research has been done since then. There's more than 25% who have problems with spasticity. The sad thing is that despite the research, not very many advances to help with the problem have been made.
ReplyDeleteI know but in 2006 when I started looking for info it seemed that these couple of researchers had bamboozeled everyone into accepting their ideas that treating spasticity did not help recovery. This was where they should have talked to survivors to find out that ADLs are not the definition of recovery. This is one of the symptoms of stroke rehab stupidity. There is no central place to find out the latest information for either the clinical staff or the survivors. Every person for themselves.
ReplyDeleteSurvival of the fittest and all. And since I am no longer in that category I should just reduce the surplus population.
Have you considered Ilooking into ITB (intrathecal baclofen) therapy? It is an alternative delivery form for baclofen that is fully programmable and enables you to take less than if taken orally. There is a one day trial available to see if you are a candidate.
ReplyDeleteI wouldn't consider ITB since mine is relatively mild and Idon't want anything that close to mine spine.
ReplyDelete