Maintaining muscle tone after brain injury
Following a brain injury, the person recovering from injury or their caretaker may experience changes in muscle tone, which is a state of tension that gives muscles their shape, even at rest. Several different types of changes in muscle tone can occur.
Types of muscle tone changes
- Flaccidity: Complete loss of muscle tone. The person is not able to start any movements with a flaccid muscle group.
- Hypertonicty: Increased muscle tone or tension. The person is unable to stop increased muscle activity.
- Hypotonicity: Less than normal muscle tone or tension. The person is not able to start or maintain enough muscle activity for the time it takes to complete an activity.
- Spasticity: Increased muscle tone or tension which increases with increased speed during stretching. The person notices there is less increase in muscle tone when trying to stretch slowly as compared to stretching quickly.
What causes these changes?
Changes in muscle tone are caused by an illness or injury involving the brain, brainstem, or spinal cord, which make up the central nervous system. The central nervous system works as a network of nerves connected to the muscles to communicate complex information back and forth between the brain and the muscles.
Normally, this information follows easily allowing the body to move easily and adjust quickly without a person’s having to think about it. After an injury, this relay system can be disrupted and the brain may not be able to process this information in the right way. This causes the balance of the system to be disturbed, which results in changes in muscle tone.
Changes can range from mild to severe and can happen in any of the muscles of the body, from the tongue to the toes, and on one or both sides of the body.
Symptoms
Changes in muscle tone affect everyone differently. Symptoms may be mild, such as the feeling of tightness in a muscle, or more severe, producing painful, uncontrollable spasms. Make sure to communicate with the medial team about how muscles are functioning.
Symptoms can interfere with mobility, self-care, and positioning. When changes limit activity, it can cause additional medical problems, including pain, sleep disturbance, joint problems, pressure sores, and pneumonia. Loss of muscle length and joint motion can lead to contractures, making joints difficult or impossible to move and performing daily care more difficult. Additionally, decreased muscle tone can lead to increased and unwanted movement in a joint, which can lead to painful positioning.
Treatment options
In order to help the healthcare team make the best decisions about treatment options, track changes in muscle tone over time. Keep in mind that some treatments are more appropriate for certain individuals, depending on the underlying cause, severity, time since injury, medical stability, location, extent, prognosis, and speed of complication development.
Rehabilitation therapies
Physical, occupational, and speech therapy are designed to maintain or improve joint range of motion and mobility, increase strength and coordination, and improve comfort. These interventions may include:
- Stretching and strengthening exercises
- Weight-bearing exercises
- Splinting
- Casting
- Positioning
- Applying hot or cold packs
- Electrical stimulation
- Taping
- Instruction and training for effective movement strategies
- Instruction and training on use of assistive devices to improve safety and stability
Medications
The use of medications for treating changes in muscle tone should be discussed with your physician. Medications can be given by mouth or feeding tube, intramuscularly (injected) and/or intrathecally (delivered directly in to the fluid surrounding the spinal cord). Medications used to treat spasticity may have side effects that can arise even after long use, including dizziness, sleepiness, weakness, fatigue, bowel and bladder issues, respiratory issues, and low blood pressure. Tell your doctor of any side effects.
Ongoing monitoring
Individuals with changes in muscle tone should be monitored on an ongoing basis to assess changes that might indicate problems. If the person is not able to communicate pain, be aware that increased spasticity can be the result of underlying medical issues such as infections, increased fluid in the brain, or other medical complications.