Controlling Spasticity in MS 2 of 4

II. TREATMENT

 

The treatment partnership

Because the condition is so individual, successful treatment of spasticity demands a true partnership between you and your doctor, nurse, physical therapist, and/or occupational therapist. Your family also plays an important role. The first step in building a good treatment partnership is knowing that treatment strategies are possible.

"Treating spasticity is not a matter of the doctor writing out a prescription for pills and saying come back in three months," said Charles R. Smith, MD, former director of the Multiple Sclerosis Comprehensive Care Centers at White Plains Hospital in White Plains, New York, and at Bronx Lebanon Hospital in the Bronx, New York.

A doctor can identify the presence and degree of spasticity by stretching your legs to check for involuntary resistance. For example, if your leg is spastic, your muscles will automatically resist when the doctor quickly bends your knee. If spasticity is mild, the doctor will feel barely any resistance; if the spasticity is severe, your leg may be so stiff that the doctor cannot bend it at all.

Treatment begins with the doctor recommending ways to relieve the symptoms. Strategies may include medication, exercise, or changes in daily activities, singly or in combination. To individualize the plan, and to adjust the dosage of any medication to its most effective level, your doctor will need to follow your progress. She or he may also make referrals to other health-care professionals, such as a physical therapist (PT) or occupational therapist (OT).

Nurses normally have responsibility for health education and for learning in detail how patients' daily lives are affected by their symptoms and are an important part of this process. Take the time to ask your nurse questions and provide personal information. Both your doctor and nurse will guide you through the sometimes tricky process of medication adjustment. In addition, the PT and OT can provide individualized training with specific exercises and ways to make daily activities easier.

 

Self-help

Spasticity, like other aspects of your MS, is in many ways unique to you. As with other MS symptoms, it tends to come and go and to be worse under certain conditions. Typical triggers include cold temperatures, high humidity, tight clothing, tight shoes, constipation, poor posture, and having a viral infection such as a cold or the flu, or a bacterial infection including skin sores or bladder infections.

In time you will become aware of the triggers that affect you most. Some, like tight shoes, can be avoided. Others merit an intervention.

Effective self-help means:

  • Don't assume that nothing can be done! Spasticity does not have to be tolerated. Improvement is usually possible.
  • Make sure an appropriate exercise program is a regular part of your routine. The National MS Society's illustrated booklets Stretching for People with MS (PDF format requires Adobe Acrobat) and Stretching with a Helper for People with MS (PDF format requires Adobe Acrobat), which are available from local chapters of the Society, include exercises specifically for spasticity. Ask your physical therapist, nurse, or doctor for suggestions.
  • Explore complementary relaxation techniques such as progressive muscle relaxation, yoga, meditation, or deep-breathing exercises. None of these is a cure, but they can make it easier to sleep at night and face the next day's problems with a clearer head and reduced spasticity.
  • If your doctor agrees, explore massage. You may even receive some insurance reimbursement depending on your plan. Massage can help relax muscles and enhance range of motion exercises and may be helpful in preventing pressure sores . However it should not be used if pressure sores or reddened areas of skin are present. The American Massage Therapy Association has a national locator service can can supply names of qualified therapists. Call 877-905-2700 or visit their Web site at www.amtamassage.org/findamassage/locator.htm.
  • Be patient but persistent through adjustments in daily activities, the types and doses of medication, the type and timing of exercise, and the use of devices, gadgets, and adaptations.

Treatment goals

Spasticity interferes with daily activities, so the primary goal of treatment is to reduce the negative effects as much as possible. Sections of this booklet detail what can be accomplished by medication, physical therapy, orthotic devices (splints or braces), and occupational therapy. Some strategies seek to relieve the affected muscles; others involve learning to work around spasticity by adopting new ways to do things.

Treatment also aims at preventing the serious complications of spasticity. These include contractures (frozen or immobilized joints) and pressure sores. Since these complications also act as spasticity triggers, they can set off a dangerous escalation of symptoms. In fact, surgical measures are considered for those rare cases of spasticity that defy all other treatments.

Contractures are not only painful and disabling, but if left untreated, they become permanent, leaving legs that can never be straightened and limiting joint mobility in such places as the shoulder. Treatment (and prevention) of contractures usually combines treatment of spasticity with medication and physical therapy, prescribed and tailored to the individual by the physician.