SPASTICITY.docx

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1. Bangladesh Health Professions Institute
Department of Occupational Therapy
Masters of Science in Occupational Therapy
Occupational Therapy in Adult Neurology

Spasticity
Spasticity is a neurological condition characterized by increased muscle tone, stiffness, and involuntary
muscle contractions. It is caused by damage to the upper motor neurons in the brain or spinal cord,
disrupting the normal balance of signals between the brain and the muscles. The mechanism of spasticity
involves several interconnected factors:
1. Upper Motor Neuron Damage: The primary cause of spasticity is damage to the upper motor neurons.
These neurons are responsible for transmitting signals from the brain's motor cortex to the spinal cord,
where they synapse with lower motor neurons that control muscle movement. Damage to the upper
motor neurons can occur due to conditions such as stroke, traumatic brain injury, multiple sclerosis,
cerebral palsy, or spinal cord injury.
2. Loss of Inhibitory Control: In a healthy nervous system, upper motor neurons not only activate muscles
but also have inhibitory connections that prevent excessive muscle contraction. When these inhibitory
connections are disrupted due to the damage, there is a lack of control over the muscle's excitability,
leading to increased muscle tone and spasticity.
3. Hyperactive Stretch Reflex: The stretch reflex is a normal protective mechanism that occurs when a
muscle is rapidly stretched. In spasticity, the stretch reflex becomes hyperactive, causing an exaggerated
and involuntary muscle contraction in response to minimal stimuli. This leads to muscle stiffness and
resistance during movement.
4. Imbalance in Muscle Activation: With spasticity, there is an imbalance in the activation of agonist and
antagonist muscles. Agonist muscles are responsible for a specific movement, while antagonist muscles
oppose that movement. In spasticity, the agonist muscles may become overly active, while the antagonist
muscles may not be sufficiently engaged, resulting in abnormal movement patterns and difficulties in
coordinating voluntary movements.
5. Development of Contractures: Prolonged and severe spasticity can lead to the development of
contractures, which are permanent shortening of muscles and tendons. Contractures can further restrict
joint movement, exacerbating the functional limitations caused by spasticity.
6. Spinal Reflex Loops: In addition to the hyperactive stretch reflex, other spinal reflex loops may also
contribute to spasticity. These reflex loops can cause abnormal patterns of muscle activation, further
exacerbating muscle stiffness and involuntary movements.
The severity of spasticity can vary from mild to severe, depending on the extent of upper motor neuron
damage and individual differences. The specific symptoms and affected muscles may differ based on the

2. underlying condition causing spasticity. Effective management of spasticity involves a multidisciplinary
approach, including physical therapy, medications, and other interventions, to reduce muscle tone,
improve function, and enhance quality of life.
The Bobath Technique
The Bobath Technique, also known as Neurodevelopmental Treatment (NDT), is a specialized approach
used in physical therapy and occupational therapy to address neurological conditions, including spasticity.
It aims to improve functional movement, reduce abnormal muscle tone, and enhance overall motor
control. While the Bobath Technique does not directly target spasticity reduction, its principles can help
manage spasticity-related issues and improve functional abilities. Here are some ways the Bobath
Technique can indirectly contribute to reducing spasticity:
1. Facilitation of Normal Movement Patterns: The Bobath Technique emphasizes facilitating normal
movement patterns and inhibiting abnormal movement patterns. By promoting more natural and
efficient movement strategies, the technique can help reduce the excessive muscle activity associated
with spasticity.
2. Use of Inhibition Techniques: The Bobath Technique incorporates inhibition techniques to reduce
spasticity. Therapists use gentle handling and positioning to calm the nervous system and reduce
hyperactive reflexes, thus helping to lower muscle tone.
3. Promotion of Muscle Lengthening: Stretching and positioning techniques used in the Bobath Approach
can help lengthen muscles, preventing or minimizing the development of contractures associated with
severe and long-standing spasticity.
4. Weight Bearing and Weight Shifting: Weight-bearing exercises and weight shifting activities are an
essential part of the Bobath Technique. These activities can promote the appropriate activation of muscles
and sensory feedback, contributing to improved motor control and potentially reducing spasticity.
5. Incorporation of Postural Control: The Bobath Approach emphasizes postural control to achieve
functional movements. By enhancing postural stability, individuals with spasticity can have better control
over their movements and potentially experience reduced spasticity during functional activities.
6. Task-Specific Training: The Bobath Technique incorporates task-specific training, where individuals
practice functional tasks relevant to their daily lives. This approach can improve motor learning and help
individuals overcome spasticity-related challenges during functional activities.
It's important to note that while the Bobath Technique can help manage spasticity indirectly, it may not
be the primary method for reducing spasticity itself. Other interventions, such as medications (e.g., muscle
relaxants), botulinum toxin injections, or surgical interventions, may be required for more direct spasticity
management. A comprehensive treatment plan, developed in collaboration with a multidisciplinary team,
is usually the most effective approach to address spasticity and its impact on an individual's functional
abilities and quality of life. If you or someone you know is experiencing spasticity, it's essential to consult

3. with healthcare professionals, such as physical therapists, occupational therapists, or neurologists, to
determine the most appropriate and individualized management plan.
The Rood Approach
The Rood Approach, also known as the Rood Technique or Rood Method, is a therapeutic approach used
to manage spasticity and other neuromuscular disorders. It was developed by Margaret Rood, a
pioneering occupational therapist, and is based on the idea that specific sensory input can influence
muscle tone and motor responses. The Rood Approach primarily focuses on using sensory stimulation and
motor patterns to influence muscle activity and improve motor control. Here are some key components
of the Rood Approach in managing spasticity:
1. Sensory Stimulation: The Rood Approach employs various sensory inputs to modulate muscle tone and
reflex activity. These sensory inputs include techniques such as stroking, brushing, and tapping the skin to
activate or inhibit specific muscle groups.
2. Rhythmic Initiation: Rhythmic initiation involves gradually increasing the range and intensity of a
movement in a smooth and rhythmic manner. This technique aims to promote muscle relaxation and
reduce spasticity by facilitating voluntary muscle control.
3. Rhythmic Rotation: Rhythmic rotation is a technique in which a therapist moves a joint in a rotational
pattern while maintaining a constant speed and force. This technique is used to reduce hypertonia
(increased muscle tone) and increase muscle relaxation.
4. Reciprocal Inhibition: Reciprocal inhibition involves the activation of the antagonist muscle to the
spastic muscle group to induce relaxation in the spastic muscles. For example, if the biceps muscle is
spastic, the triceps muscle is activated to inhibit the biceps' activity and promote relaxation.
5. Heavy Work: Heavy work refers to activities that require significant muscle effort and exertion. Engaging
in heavy work can help reduce spasticity by promoting normal muscle activation and sensory feedback.
6. Tapping and Vibration: The Rood Approach may use tapping or vibration techniques to provide sensory
input to muscles and joints, influencing muscle tone and reflex responses.
7. Verbal and Visual Cues: Verbal and visual cues are often used to facilitate motor responses and enhance
functional movements. These cues can help individuals with spasticity better coordinate their movements
and improve motor control.
It's essential to note that the Rood Approach is just one of many therapeutic approaches used to manage
spasticity. Each individual's response to therapy can vary, and the Rood Approach may not be suitable for
everyone. The management of spasticity often requires a comprehensive and individualized treatment
plan, which may include a combination of therapies, medications, and other interventions based on the
underlying cause and the individual's specific needs and goals. If you or someone you know is experiencing

4. spasticity, it's crucial to work with healthcare professionals, such as occupational therapists, physical
therapists, or neurologists, to determine the most appropriate and effective treatment approach.
Inhibition techniques
Inhibition techniques are used to reduce spasticity by calming overactive reflexes and reducing muscle
tone. These techniques focus on providing sensory input to the muscles and nervous system in specific
ways to promote relaxation and decrease muscle hyperactivity. Here are some common inhibition
techniques used for managing spasticity:
1. Stretching: Gentle and sustained stretching of spastic muscles can help lengthen the muscle fibers and
reduce muscle tone. Stretching should be performed carefully to avoid triggering the stretch reflex
excessively.
2. Prolonged Pressure: Applying prolonged, firm pressure to a spastic muscle or its tendon can help reduce
muscle tone. This technique, known as prolonged pressure or deep pressure, can be achieved using hands,
elbows, or therapeutic tools.
3. Weight Bearing: Weight bearing involves applying pressure or bearing weight on a spastic limb, which
can help decrease muscle tone and promote better alignment and control of movements.
4. Neutral Warmth: Applying a warm, moist compress or using warm water during hydrotherapy can have
a relaxing effect on spastic muscles.
5. Neutral Warmth: Applying a warm, moist compress or using warm water during hydrotherapy can have
a relaxing effect on spastic muscles.
6. Slow, Deep Tapping: Slow, deep tapping (also known as rhythmic tapping) on the skin overlying spastic
muscles can help stimulate the Golgi tendon organs, which leads to reflex relaxation of the muscle.
7. Rocking: Gentle rocking movements can be used to encourage relaxation and reduce muscle tone. This
technique is often applied to the whole body while the person is in a comfortable and supported position.
8. Slow Rolling: Slowly rolling or rocking a body part can help decrease spasticity and promote relaxation
of the involved muscles.
9. Facilitation of Inhibition Responses: Providing sensory input to specific areas of the body or specific
muscles can trigger inhibitory responses and reduce muscle tone. For example, applying gentle pressure
or touch to certain points on the body may help induce relaxation.
10. Inhibitory Casting or Splinting: Customized splints or casts can be used to position spastic limbs in a
way that promotes relaxation and reduces muscle tone over time.

5. It's important to note that while inhibition techniques can be helpful in managing spasticity, their
effectiveness may vary among individuals. Furthermore, a comprehensive approach to spasticity
management often includes a combination of therapies, medications, and other interventions based on
the individual's specific needs and the underlying cause of spasticity. Healthcare professionals, such as
physical therapists, occupational therapists, or neurologists, can provide guidance on selecting the most
appropriate and effective inhibition techniques for managing spasticity.