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Stroke Smart Magazine

May/June 2009

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How to Tone it Down After a Stroke

By David Dansereau

Spasticity is tight, stiff muscles that make movement, especially of the arms or legs, difficult or uncontrollable. Exercise can be an important part of the health care regimen to tone down spasticity. Before we explore this, however, you should first understand how your brain con­trolled your muscles before your stroke and what might be happening on the inside now that your brain was injured.

Before your Stroke

Your brain communicated to your muscles through your spinal cord and told your muscles when to tighten and relax to help control movement.

The muscles in your limbs had finely tuned sets of stretch receptors to tell the brain how much tension they are under. This helped the brain move the body safely to avoid injury.

After your Stroke

If your stroke damaged the part of your brain that controlled movement of muscles, your brain might not be hearing those important signals from the affected muscles. The body goes into a “safe mode” to keep the limbs protected.

When the damaged brain is no longer able to understand the usual signals from the muscle, the spinal cord might send its own impulses to the muscles in those limbs to remain contracted, or tight, so the muscles don’t get overstretched and torn.

Negative Effects of Spasticity

  • Stiffness in the arms, fingers or legs.
  • Painful muscle spasms.
  • A series of involuntary rhythmic contractions and relaxations in a muscle or group of muscles that lead to uncontrollable movement or jerking, called clonus
  • Increased muscle “tone.”
  • Abnormal posture.
  • Hyperexcitable reflexes

Reset Spasticity and get out of ‘Safe Mode’

When your computer senses it might be in danger of losing vital data, it reacts by going into safe mode. Yes, you can ignore this signal from your computer and continue to work (at lower performance) in safe mode or you can reset/reboot your computer and free up memory to improve performance.

Just like on your computer, the safe mode in your body (spasticity) causes an eventual loss in move­ment control through uncontrollable muscle tight­ness. To reset your muscle connection and tone down spasticity, you’ll need to give your brain a boost to free up more memory for recovery. One of your best recovery tools to help your brain regain control is exercise.

Rewiring the injured area in the brain through exercise takes repeated, consistent practice and is hard work. But it is that hard work that makes the brain change and improve (neuroplasticity) for voluntary movement to return. As the brain retakes responsibility for muscle control, spasticity can lessen or stop, restoring the use­fulness of the limb and normalizing movement.

Here are exercise-based options for toning down spasticity:

  • Robotics to provide physical assistance.
  • Virtual reality, exercise games and mental practice such as “Wii-habilitation,” using a Nintendo game console to make exercises fun and interesting.
  • Bilateral training: repetitive, simultaneous movement.
  • Constraint-induced therapy: forcing the use of the affected side by restraining the unaffected side.
  • Functional electrical stimulation (e-stim) with biofeedback: A treatment that stimulates nerves by sending an electrical current through the skin while monitoring the muscle activity.

In addition to traditional medical treatment, speak with your health care provider to determine what exercise or health programs might be most beneficial to you and your unique needs. Be sure to keep up with the program to tone down spasticity.

David Dansereau, MSPT, is a physical therapist and private practitioner in Providence, R.I. He also is a stroke survivor. Learn more about Dansereau by going to www.my-physical-therapy-coach.com.


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