Friday, 23 September 2011

Spasticity and disability

Sosnoff et al. Influence of spasticity on mobility and balance in persons with multiple sclerosis. J Neurol Phys Ther. 2011 Sep;35(3):129-32.


Background: Spasticity (stiffness of muscles) presumably affects mobility and balance. This study examined whether or not MS'ers with spasticity in their lower legs have more impairment of mobility and balance compared to those without spasticity.


Methods: 34 ambulatory MS'ers underwent measurements of spasticity in the calf muscles of both legs, using an outcome measure call the modified Ashworth scale. They also had their walking speed (timed 25-foot walk), mobility (Timed Up and Go), walking endurance (6-minute walk test), self-reported impact of MS on walking ability (Multiple Sclerosis Walking Scale-12), and balance (Berg Balance Test and Activities-specific Balance Confidence Scale) measured.


Results: 15 MS'ers had spasticity of the calf muscles based on the modified Ashworth scale scores. The spasticity group had greater disability (P=0.03). Mobility and balance were significantly more impaired in the group with spasticity compared to the group without spasticity. 


Discussion: Spasticity in the calf muscles has a negative effect on mobility and balance in MS'ers. The relationship between spasticity and disability in persons with MS requires further exploration.

"As a neurologist this study is stating the obvious, i.e. MS'ers with spasticity are more disabled. In MS spasticity and weakness go hand-in-hand so the findings of this study are not surprising. What is more important is early spasticity; when MS'er start to realise that they have stiffness and muscle spasms as a result of their disease. Does treating spasticity at this stage improve physical functioning?"

"Unfortunately, the licensed drugs for spasticity are associated with unpleasant side effects, mainly sedation and poor cognition; we therefore tend to delay initiaiting them for as along as possible."

"Our group are working on developing new anti-spasticity drugs with fewer side effects to overcome this problem."

"An important exception to starting anti-spasticity drugs is night-time leg spasms that often wake MS'ers in the early hours of the morning or interrupt their sleep. This often leaves MS'ers tired in the morning due to poor quality sleep. In my experience this is also an important contributor to MS-related fatigue. Giving a longer acting anti-spasticity drug at night, for example clonazepam, often helps resolve this problem and improves MS'ers daytime functioning."

"It is also important to make sure that any bladder problems are addressed at the same  time as night time leg spasms; having to get up frequently at nigh to pass urine is another cause of poor sleep. We also have medication to treat this problem."

"So if you have night-time leg spasms or bladder problems that are affecting your sleep please discuss this with your neurologist so that you can be treated. You will be surprised how much better you feel after a good nights sleep."

1 comment:

  1. Is it me or this research is really junk? They say the obvious and, of course, they can do nothing. This should be only printed on toilet paper.

    ReplyDelete

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