It was decided, after time in a rehab ward, that my sister was not able to progress to further rehab after a serious thalamic haemorrhagic stroke. Physio at the hospital rehab ward stopped and she was transferred to a care home. I am so concerned that her affected right arm and hand is contracting. The elbow is severely contracted and her hand now is pushing into her neck. I’m trying to remind carers at the home to position cushions correctly. She did not wear the hand splint for a while and now the fingers are contracting and it’s getting harder for carers to clean this inside, palm etc. Difficult to cut her nails and her long thumb nail was pressing into her neck. I’ve been told this will only get worse. Has anyone found a method to overcome or help this? I can go in about four times a week for two to three hours. She has lost capacity and is not able to do any exercises herself. A young masseuse goes twice a week, and is very good at relaxing the fingers, though can’t get the hand completely open. Any suggestions welcome. Thank you.
Yes, you are up against the (very nearly) impossible. I overcame severe spasticity and contracture (44 days in bed in hospital) ; I know these problems. Not in my arm though. Very hard to find ppl who can help you.
Research in depth
- THC (rather than CBD) can overcome spasticity
- Arjan Kuipers who put up https://www.brain.rehab/ has a method to bypass higher brain function damage in stroke
- Vitamin D 30,000 IU with co-factors
- Grounding / Earthing to recalibrate electrical zero reference point for body - this eliminates muscle hyper tone
- Nutrition & exercise (customized) / Wheatgrass juice at the minimum / liposomal C
https://www.youtube.com/channel/UCekGYDKocAxZUANcv9P_fYw
If her stroke was more than 26/42 on the NIH severity scale, then I’m out of my depth.
Good luck, Roland
@Searching hi & welcome to the community. Sorry to hear of your sisters stroke. It sounds like you have a lot to deal with there.
@pando has shared some useful info. The only other thing I can offer is some people have botox to help with spasticity. Whether that is appropriate in this case I’m not sure but may be worth a look into.
Wisging you all the best
Ann
Ann’s right; if it’s a losing battle then yes botox to relieve. But if it’s a winning battle then stay away from it. I resisted the temptation and overcame problems. Most people succumb.
My little list of 5 tips is far from easy to understand & follow ; but this is what worked/works for me.
Good luck, R
Hello @Searching - Welcome to the forum.
I do not have anything to add beyond what @pando and @Mrs5K have already suggested.
To address the finger contraction, we used stress relieving balls and rolled up cotton flannels to put in Mum’s palm to help keep fingers from contracting. As the fingers loosen, you can increase the size of the roll to increase the opening of the fingers.
Clipping nails is something you may have to do as carers may not always have time and patience needed to do this.
Other than that, I can only offer you moral support and wish you and your sister all the very best.
Namaste|
Spasticity is a motor disorder characterized by velocity-dependent increased muscle tone and exaggerated tendon reflexes. It often occurs due to damage to the central nervous system (CNS), particularly the brain or spinal cord, and is commonly seen in conditions such as stroke, multiple sclerosis, cerebral palsy, and spinal cord injury. The gamma loop plays a significant role in the development of spasticity, as it is involved in regulating muscle tone and reflex activity.
Here’s how spasticity and the gamma loop are interconnected:
Role of the Gamma Loop in Normal Muscle Tone
-
Gamma Motor Neurons:
- Gamma motor neurons innervate intrafusal muscle fibers within muscle spindles, which are sensory receptors that detect changes in muscle length and velocity.
- When gamma motor neurons are activated, they increase the sensitivity of muscle spindles to stretch.
-
Stretch Reflex:
- When a muscle is stretched, the muscle spindles detect this change and send sensory signals (via Type Ia afferent fibers) to the spinal cord.
- These signals activate alpha motor neurons, causing the muscle to contract and resist the stretch. This is the stretch reflex (e.g., the knee-jerk reflex).
-
Coactivation of Alpha and Gamma Motor Neurons:
- During voluntary movements, the brain coactivates alpha and gamma motor neurons to ensure that muscle spindles remain sensitive to stretch even as the muscle contracts.
How Spasticity Develops
Spasticity arises when there is damage to the CNS (e.g., the motor cortex, corticospinal tract, or other descending pathways). This disrupts the normal regulation of the gamma loop and stretch reflexes, leading to:
-
Loss of Inhibitory Control:
- The CNS normally exerts inhibitory control over reflex pathways to prevent excessive muscle tone and reflex activity.
- Damage to the CNS reduces this inhibition, leading to hyperexcitability of the stretch reflex.
-
Overactivity of Gamma Motor Neurons:
- In spasticity, gamma motor neurons may become overactive, increasing the sensitivity of muscle spindles to stretch.
- This results in an exaggerated stretch reflex, even in response to minor stretches.
-
Increased Muscle Tone:
- The overactive stretch reflex causes muscles to contract excessively, leading to hypertonia (increased muscle tone).
- This tone is velocity-dependent, meaning it increases with faster stretching of the muscle.
-
Clonus and Spasms:
- In severe cases, the hyperexcitability of the stretch reflex can lead to clonus (rhythmic, involuntary muscle contractions) or spasms (sudden, involuntary muscle contractions).
Key Features of Spasticity
- Velocity-dependent resistance to stretch: Muscle tone increases when the muscle is stretched quickly.
- Exaggerated tendon reflexes: Reflexes such as the knee-jerk reflex are overly strong.
- Clonus: Rapid, rhythmic contractions of a muscle when it is stretched.
- Spasms: Sudden, involuntary muscle contractions.
- Abnormal posturing: Spasticity can cause limbs to assume abnormal positions due to increased muscle tone.
Treatment of Spasticity and the Gamma Loop
Treatment strategies for spasticity often target the gamma loop or its downstream effects:
-
Medications:
- Baclofen: A GABA-B agonist that reduces the activity of alpha and gamma motor neurons.
- Benzodiazepines: Enhance GABAergic inhibition in the CNS.
- Botulinum Toxin: Injected into spastic muscles to block acetylcholine release, reducing muscle contraction.
-
Physical Therapy:
- Stretching and strengthening exercises can help reduce muscle tone and improve mobility.
- Serial casting or splinting may be used to maintain muscle length and prevent contractures.
-
Surgical Interventions:
- Selective Dorsal Rhizotomy: A procedure that involves cutting overactive sensory nerve roots to reduce spasticity.
- Intrathecal Baclofen Pump: Delivers baclofen directly to the spinal cord to reduce spasticity.
-
Neuromodulation:
- Techniques such as transcranial magnetic stimulation (TMS) or spinal cord stimulation may help modulate neural activity and reduce spasticity.
Summary
Spasticity is a result of disrupted CNS control over the gamma loop and stretch reflex pathways. Damage to the CNS leads to overactivity of gamma motor neurons, increased muscle spindle sensitivity, and exaggerated stretch reflexes. This results in velocity-dependent increased muscle tone, spasms, and clonus. Treatment focuses on reducing gamma loop activity, enhancing inhibition, and improving muscle function through medications, therapy, and surgical interventions. Understanding the role of the gamma loop in spasticity is crucial for developing effective treatments.
There’s an exercise called The Tipster in a book called The Successful Stroke Survivor by Tom Balchin. It opens the hand. I’ve seen it done. It’s amazing. It takes an extra pair of hands to help but it’s a good starting point.
Thank you, I’m out of my depth too, but I’ll follow up your suggestions.
Thank you so much. She is due to be seen for possible Botox in a couple of months time.
The cotton flannels are a great idea, and, I will have to get used to the nail clipping! Thank you so much for your moral support.
Thank you.I’ll have to read all of this again, but understand gentle stretching done berybregulatprly is the beginning f how to treat.
Stretching done regularly!
I’m writing this as I try and stop my elbow bending (high tone in the bicep. This is all because didn’t do my daily exercises yesterday. My muscles contract if I don’t stretch and work on them daily, but it’s a fine line between too much and not enough exercise.
Botox can be transforming if you can find someone who does it (there isn’t anyone currently in my area).
Muscle relaxing drugs can assist.
I wear a splint on my hand at night to stop finger contractions. I wouldn’t be able to sleep without it.
Most important - the longer your sister goes without doing anything, the worse it’s going to get.
Seek advice from your GP on medication and services in your area.
Stroke services can be tricky to find in her area. I’ve had more assistance from my local MS Centre (which is now changing its status to a Neuro Rehab Centre) which provides many different therapies and is a fount of knowledge with excellent physios.
Thank you, this is very helpful. And you confirm what I’ve gathered from private physio. it will get worse without interventions. Trouble is it’s gone quite far already. She was discharged from the hospital with no appointments or instructions for ongoing care of the arm… it was like, you’re not fit enough for ongoing rehab, so physio stops now. As she has lost capacity, she’s not able to do her own exercises, and carers at the home not really qualified to do them. So it’s down to me and a young masseuse who has the knack of opening the hand. Your mention of the neuro centre and MS is useful too. I feel there should have been ongoing care of some kind stressed in her discharge letter but there was nothing. Good luck to you. And keep doing your exercises. Though it sounds like quite a painful task.
Right, I saw an image of the exercise. Don’t think she can use as her elbow is tightly contracted… Thank you though.
I just remembered, we used a palm protector.
You can buy it online - look for Jura Palm Protector (this is what we use) but there are others available.
Does your sister have any help from OT/PT - maybe they can order it for her, but that may take time. You might be better taking the hit on this occasion to help your sister and buy it online. Left and right hand, so buy the correct one if you doing it yourself.
Looks good. Does it work? Thumb might be awkward for my sister, it’s so tight across her palm but a great idea. Thank you!
It worked for us. The palm is protected and so the nails cannot dig into it. The thumb needs to be fed through the loop - it’s a big enough loop and it is fleeced so cannot do harm. Adjust to cover palm with fleece and use velcro strap to keep in place.
You can add extra padding once fingers loosen to thicken the pad and open the fingers further.
You will need to flex the fingers to get the muscles working. Not sure if your sister can do some of these things herself.
Wish you all the best.
Hi I suffer from dystonic muscle spasms in my effect hand wrist and elbow to the point where my hand would turn inwards, creeping up to my shoulder. Some days the pain was severe, and clenched fist was constant from contracting. I had my stroke age 11, and until I was 18 I could no longer get the right fix with medication and aids, I had a huge decline in mental health and it began pulling all my left side and making my walking harder. I was so self conscious, short story my Gp referred me to botox, which didn’t work straight away but I stuck with them and to. These injections were a life saver to myself. I can relax my arm use my arm better and hold my purse handbag pots pans. I can hold a piece of paper flat with open fingers to sign my name. the injections don’t work for everyone but mine last 12-15 weeks, when the injections wear off I use a night splint to aid contractions to help relax it. I also wear a Flexi lycra glove in the house watching tv relaxing at night, it just helps separate my fingers and is not uncomfortable its a light weight glove. These aids were given to myself as part of the nureo rehabilitation team OT ask your gp for referral in your area for your sister. wish you all the best
This is so helpful, thank you so much. How shocking that you should have a stroke at so young an age. those early years sound like a torment. What a massive relief it must have been to find that the Botox could help. My sisters hand is clenched right up to and pressing against her neck. Do you any more info for the flexi glove you mention? I wonder if one is available online? I will definitely read and absorb your suggestions. Thank you so much again.