Breaking Down Spasticity: Understanding the Effects of Stroke on Muscle Control

May is National Stroke Awareness Month and is dedicated to educating the public about signs and symptoms before a stroke, how to live after having a stroke, and the possible symptoms your body may experience that occur following a stroke.

After a person has a stroke, a variety of side effects can develop including a very serious and debilitating symptom called Spasticity. This condition leads to involuntary muscle contractions and can affect the muscles in a number of ways causing them to become stiff or tight. Most often, spasticity causes the hand to become clenched and fingers to curl. Severe spasticity in the hand is due to miscommunication between the brain and the muscles, causing the muscles that control the hand to spasm and gradually tighten. If left untreated, spasticity can contribute to the development of extreme stiffness or shortening in the muscles, joints, and connective tissue known as contractures.

The later effects of spasticity developing into contractures include causing the range of motion of the fingers and wrist to become even more restricted and resulting in the fingers curling into the palm.

It’s important to take spasticity seriously by managing it early enough to prevent contractures from developing. This will help maximize a patient’s mobility function and avoid the increased pain or discomfort that can be accompanied by contractures. However, even if spasticity has progressed to the point of contractures, there are still ways to gradually relax the muscles in the hand and fingers, although this will require time and consistency.

Fortunately, thanks to modern healthcare treatments, it is possible to rewire the brain and restore mobility in the hand and fingers. Be sure to work alongside your VA occupational or physical therapist so they can help set you up for success by providing optimal exercises, splints, and other rehab techniques to reverse or control the effects of spasticity.

If you or a loved one has had a stroke and are experiencing debilitation of movement in your hands, you can expect your VA Occupational or Physical therapist to recommend treatments to help relax spasticity in the fingers through several methods including:

Hand Splints:  are often prescribed to optimize daily stretching as these devices can provide long-duration, low-load stretching to the muscles and joints of the hand and finger. Stretching the hand muscles and connective tissue helps prevent spasticity from worsening into contractures. It’s important to perform the stretch in a pain-free range.

The SaeboStretch is a resting dynamic hand splint (hand/wrist orthosis) that helps Veterans affected by stroke manage spasticity while minimizing joint damage and pain.

• The stretch technology assists in preventing or reducing joint damage and pain. With hard static splints, there is increased pressure at the finger joints. The dynamic, flexible SaeboStretch hand plates reduce the pressure at the joints by allowing the hand plates to bend with the fingers when the tone increases.
• Stretch comfortably to increase motivation and compliance safely, allowing your fingers to relax while preventing cuts, sores and hygiene issues associated with sweat and fingernails digging into the palm of your hand.
• Includes three interchangeable hand pieces that can accommodate various levels of spasticity to help improve motion.
• The proprietary strapping system uses key anatomical points for maximizing control and ensuring an intimate fit, along with a malleable wrist and thumb mount for further customization.
• Designed with a comfortable non-slip cover and straps to keep fingers in the desired position and an adjustable thumb system to allow for radial and palmar adduction/abduction.
• Cover features a zipper closure which can easily be removed for cleaning to promote hand hygiene.
• Can be worn for numerous hours and while sleeping to obtain the maximum benefits and preserves the integrity of the skin.

Hand Spasticity Exercises: Exercise is arguably the most effective intervention for hand spasticity after stroke. Practicing therapeutic hand movements on a consistent basis helps spark neuroplasticity: the process the brain uses to rewire itself.

As hand spasticity exercises are practiced with high repetition, the brain works to create and strengthen neural pathways that communicate with the affected hand muscles.

As the brain starts to regain the ability to send signals to the affected hand, it also regains the ability to send signals that tell the hand and fingers to relax, decreasing spasticity.

Passive Hand Exercises: are utilized when active hand exercises are not yet an immediate ability and can still be used to help reduce spasticity. Passive exercise involves assisting your affected wrist, hand and fingers through their range of motion with a prolonged passive muscle stretch. This can be done by using your non-affected side to move your hand or can also be performed with the help of a caregiver or therapist.

The following range of motion exercises are for the wrist and hand that a Veteran can do for him/herself without a caregiver.

Prepare for exercise:

• clasping your hands together, can be completed seated or laying down.
• 10 repetitions for each exercise and hold the joint at the end range for a total of 1 to 3 seconds, in a pain free zone.

Wrist Flexion and Extension - bend your wrist slowly side to side.

Wrist Supination and Pronation - Turn weak hand palm up and then palm down.

Finger Flexion and Extension - Bend fingers of weak hand into palm then straighten. If hands are already fisted, then only work on straightening fingers.

Thumb Flexion and Extension Move thumb to little finger. Then bend and straighten the thumb out to the side to stretch the "web space"

Every stroke is different, and every Veteran will benefit from different approaches throughout the stages of recovery. Talk to your VA occupational or physical therapist today to see which treatments and products are most suitable for you!