Stroke Recovery - Training of Muscles Affected By The Upper Motor Neuron Syndrome

Training of Muscles Affected By The Upper Motor Neuron Syndrome

Muscles affected by the Upper Motor Neuron Syndrome have many potential features of altered performance including weakness, decreased motor control, clonus (a series of involuntary rapid muscle contractions), exaggerated deep tendon reflexes, spasticity and decreased endurance. The term "spasticity" is often erroneously used interchangeably with Upper Motor Neuron Syndrome, and it is not unusual to see patients labeled as spastic who demonstrate an array of UMN findings.

It has been estimated that approximately 65% of individuals develop spasticity following stroke, and studies have revealed that approximately 40% of stroke victims may still have spasticity at 12 months post-stroke. The changes in muscle tone probably result from alterations in the balance of inputs from reticulospinal and other descending pathways to the motor and interneuronal circuits of the spinal cord, and the absence of an intact corticospinal system. In other words, there is damage to the part of the brain or spinal cord that controls voluntary movement.

Various means are available for the treatment of the effects of the Upper Motor Neuron Syndrome. These include: exercises to improve strength, control and endurance, nonpharmacologic therapies, oral drug therapy, intrathecal drug therapy, injections, and surgery. Researchers do not believe that treating spasticity is worthwhile. A letter to the editor of Stroke magazine. Spasticity After Stroke: Why Bother? William M. Landau, MD However, the perseverative preoccupation of professional neurologists and therapists with the purpose of overpowering the spasticity ogre seems to be an endemic, intractably-taught delusion that afflicts both scholars and clinicians. Another group of researchers writing in Movement Disorder Virtual University Incidence and Consequences of Spasticity After Stroke

The authors conclude, “spasticity seems to contribute to motor impairments and activity limitations and may be a severe problem for some patients after stroke,” but, they note, “Our findings support the opinion…that the focus on spasticity in stroke rehabilitation is out of step with its clinical importance. In a survey done by the National Stroke Association, however, while 58 percent of survivors in the survey experience spasticity, only 51 percent of those have received treatment for this condition.