"I had the chance to meet Anne-Laure Chatain to discuss a complementary approach to the care of cerebral palsy patients. After several months of work in the Brain-Moove center with this material and this approach, I can confirm the contribution of this one on spasticity and the integration of the body schema in this type of patients."
Raphaël ROYER DC. Head of the Brain-Moove Center.
September 22, 2021
What treatments for spasticity? Discover this article written by Anne-Laure Chatain, MKDE & Allyane practitioner.
I. Spasticity, a few reminders
Spasticity is a frequent and disabling consequence of neurological accidents. It is the consequence of a lesion of the pyramidal system as in the aftermath of a stroke, multiple sclerosis (MS), spinal cord injury (para/tetra paresis/plegia), cerebral palsy (CMI, IMOC) etc.
This so-called positive symptom of the pyramidal syndrome is defined by an increase in the tonic stretch reflex, which is speed dependent. This pyramidal hypertonia is elastic like a spring: the resistance increases with the stretching speed. This means that the muscle contracts in an exaggerated reflex manner during a sharp stretch.
This spasticity to stretching is quantifiable (Ashworth, Held and Tardieu scale...) at the bedside. It is thus the clinical criterion of reference which allows to quantify this hyperexcitability of the motor neuron.
II. Spasticity, what are the repercussions?
This hypertonia can be necessary to maintain certain functions but can also be disabling for the locomotor system.
In the aftermath of a stroke, it is described as the first sign of the onset of a first stage of motor skills.
Muscular hypertonicity is sometimes the only motor capacity that can be mobilized to ensure postural maintenance; for example, spasticity of the quadriceps makes it possible to lock the knee and thus to stand.
Spasticity also presents a great variability in its intensity, depending on individual emotional and environmental factors (stress, heat/cold, etc.). It is also increased in case of irritative spines (cutaneous such as bedsores, visceral such as bladder globe, presence of infections). It is then a warning signal of the body to be taken into account especially in the patients having a sensitive attack.
On the other hand, muscle spasms due to spasticity are often described as painful cramps by patients. In addition, there is the pain generated by the abnormal position in which a limb is held due to spasticity. Indeed, when the spastic muscle is permanently contracted and no longer stretched, over time the muscle fibers shorten and the muscle retracts. This leads to stiffness, or even joint ankylosis, placing the limb in an abnormal position and increasing the sensitive support surfaces that generate possible pressure sores. This hypertonia, which cannot be controlled by the patient, prevents the limb concerned from being able to move; it is frozen.
In the case of "moderate" spasticity, ankylosis is more rare. On the other hand, this spasticity generates daily motor disorders. In addition to fatigue, the contraction of antagonist muscles becomes more difficult: they must fight against the lack of relaxation of spastic muscles to mobilize a joint.
In the lower limbs, the muscles affected are generally those of the extension chain (sural triceps, quadriceps and adductors). Motor disorders are then manifested during walking: slowness, instability, modification of the kinematics of walking ("robotic" gait), impossibility of putting the foot on the ground. There is also an inability to stand upright and a deterioration in comfort (when lying down or sitting).
For the upper limbs, the spastic muscles are generally those of the flexion chain (pectoralis major, biceps brachii, brachialis, flexors of the carpus, pronators, flexors of the fingers and thumb adductor). Spasticity of the upper limbs can have serious consequences in daily life: the hand can be non-functional and a bent upper limb complicates or even prevents many activities, such as eating, washing, dressing, etc. Motor disorders result in a lack of skill or significant fatigue.
Spasticity therefore has a strong impact on the comfort and quality of life of patients, especially since it is totally variable and therefore unpredictable according to the various daily situations.
III. Spasticity, which treatments?
There are different types of therapeutic strategies to fight against spasticity: sensory-motor re-education with spasticity inhibition (Bobath, stretching, motor vibrations), functional electrostimulation, pharmacological treatment (oral antispastics), injection of botulinum toxin or even surgical treatment (baclofen pump, neurotomy).
Their objectives are to increase motor control on the one hand, and on the other hand to reduce segmental spasticity as needed in order to restore a desired motor function.
The Allyane method now offers a new non-intrusive approach to the management of this spasticity. It is a complementary tool in rehabilitation allowing to obtain clinical results in the short and medium term.
Indeed, the contribution of neurosciences has made it possible to discover that the brain has great capacities of adaptation and recovery (cerebral and neuronal plasticity). [1], [2]
Proprioceptive stimulation in the development of a movement is well established. [3] [4]
On the other hand, mental imagery and more particularly motor imagery allows the maintenance of neuro-sensory affluence (essentially visual) and motor performance by cortical training. [5], [6], [7], [8].
Specific low frequency sounds, generated by a medical device, will increase the emission of alpha brain waves allowing the hyperactivation of motor areas.
This is why the proprioceptive sensations of the patient are integrated into motor imagery, coupled with low frequency sounds. By this means, it is the image of the gesture that we try to correct or recreate.
The treatment of sural triceps spasticity by the Allyane method allows an average reduction in the Ashworth score of 1.41 points, obtained in 91% of patients treated and maintained at one month in 70% of them. [9] [10] [11].
Bibliography:
[1] Cofemer : Rode G, Jacquin-Courtois S, Yelnik A. Rééducation des accidents vasculaires cérébraux ; page 13. Septembre 2008.
[2] Jeannerod M. Plasticité du cortex moteur et récupération motrice. Motricité cérébrale, vol.27, n°2, pp.50-56. 2006.
[3] Formento E, Minassian K, Wagner F, Mignardot JB, Le Goff-Mignardot CG, Rowald A, Jocelyne Bloch J, Micera S, Capogrosso M, Courtine G. Electrical spinal cord stimulation must preserve proprioception to enable locomotion in humans with spinal cord injury. Nature neuroscience Oct 2018
[4] Avanzino L, Bassolino M, Pozzo T, Bove M. Use-dependent hemispheric balance, J Neurosci , 2011, vol. 31 (pg. 3423-3428)
[5] Oostra KM, Oomen A, Vanderstraeten G, Vingerhoets G. Influence of motor imagery training on gait rehabilitation in sub-acute stroke: A randomized controlled trial. J Rehabil Med. 2015 Mar;47(3):204-9. doi: 10.2340/16501977-1908
[6] Mateo S, Di Rienzo F, Bergeron V, Guillot A, Collet C, Rode G. Motor imagery reinforces brain compensation of reach-to-grasp movement after cervical spinal cord injury.Front Behav Neurosci. 2015 Sep 11;9:234. doi: 10.3389/fnbeh.2015.00234. eCollection 2015. Review
[7] Ehrsson H., Geyer S., Naito E. – Imagery of voluntary movements of fingers, toes and tongue actvates corresponding body-part specific motor representations – Journal of Neurophysiology, n°90, 2003, pp.3304-3316
[8] Rulleau T, Toussaint L. L’imagerie motrice en rééducation. Kinesither Rev . Avr 2014
[9] Chatain AL, Impact of neuro-cognitive reprogramming in spasticity rehabilitation. Accepted poster in the ESO-WSO Virtual Conference, 7-9 november 2020
[10] Chatain AL, Apport d’une reprogrammation neuro cognitive dans la prise en charge de la spasticité́. Communication et e-poster aux e-JNLF 4-6 septembre 2020.
[11] Chatain AL, Apport d’une reprogrammation neuro cognitive dans la prise en charge de la spasticité́. Poster présenté aux 2èmes Journées de la Société Française Neuro-Vasculaire SFNV, Issy les Moulineaux, Nov 2019.
Physiotherapist taking care of patients with central neurological disorders since 2008. She regularly participates in trainings and congresses in order to constantly update her skills. She has been a neurology trainer and certified Allyane practitioner since 2018.
Article posté le 20/01/2022
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