To many, the term “muscle tone” calls to mind exercises and nutritional supplements, but in pediatric neurology, muscle tone refers to the tension that exists in muscles and allow them to function. This tension is always present to some degree in muscles; it allows balance and the performance of complex tasks like walking or typing through a constant web of interactions with the brain along the nervous system. In neurological terms, tone can be thought more of as a musical note that hums through your muscles like a vibrating violin string, allowing them to function correctly.
Spasticity is a spectrum of neurological conditions that arises in children when their brain or nervous system is compromised and their muscle tone becomes discordant, or like tightening the strings on a violin, they have a high tone causing stiff muscles, uncontrolled movements and even pain.
Symptoms of Spasticity
Because childhood spasticity affects the muscles, it can be recognized through common signs like involuntary movements, muscle spasms and jerkiness over prolonged periods of time. Exaggerated reflexes as well as stiffness in the joints are other common signs of spasticity.
Another common sign of spasticity in children is an abnormal and involuntary positioning of fingers, arms, legs and toes, both in a curled or flexed positions. Children with spasticity often keep their legs crossed in a scissor position and may have difficulty walking. Constant soreness in the muscles and joints along with pressure sores and red skin are other markers of spasticity.
Though spasticity in children is a spectrum of disorders that can vary greatly in their severity, signs like these will usually manifest repeatedly over time. Simply having a single spastic movement on its own may not be a sign of neurological disorder, however, any such incident should be noted and mentioned during regular well-child checkups.
What Causes Spasticity?
Perhaps the most common cause of spasticity in children is cerebral palsy, which arises due to brain damage normally occurring before or during birth. Some children can develop cerebral palsy after birth, though that is less common.
The brain damage associated with cerebral palsy is often associated with children who are born prematurely, or who have low-birth weights. Children who are born in multiples, such as twins or triplets, are also at greater risk of developing cerebral palsy. Though less common, cerebral palsy can also arise in infants and small children due to environmental factors such as lead poisoning, meningitis or shaken baby syndrome.
Early signs of cerebral palsy begin showing before the age of 2 or 3 years old, and typically progress until the child is around 5 years old. Though the symptoms may become more pronounced between birth and early childhood, the disease does not get progressively worse over time.
Cerebral palsy can also affect the muscles in the head and face, creating problems with speech, sight and hearing. Learning disabilities can also be present.
Aside from cerebral palsy, other disorders arising from both disease and trauma can also cause spasticity in children. Spina bifida, a disorder in the development of a child’s spine is also a common cause of spasticity. Damage to the spine or nervous system in general can cause spasticity.
Treatments for Spasticity
Treatments for spasticity depend on both its cause and also the goals set by the family and pediatric neurology team to ensure the best outcome possible for the child.
Not all treatment methods are suitable for all situations, so a team of pediatric neurologists and specialists will work with the child’s family to determine the best treatments that will improve the life of the child.
Occupational, physical, and speech therapies are often employed to give teach and develop the mastery of skills that help children develop and maintain the tools needed to live a fulfilling life.
Medication can be employed to reduce the severity of the child’s spasticity, including the surgical insertion of a baclofen pump which releases a constant stream of very small doses of medicine directly to the child’s spine. Administering medicine through the device minimizes side effects such as sleepiness that are caused by taking the medicine orally.
BOTOX® injections into spastic muscle tissue of the legs or arms has also been found to be an effective treatment and aid for therapy. The results of one of one BOTOX® treatment lasts between three and six months.
Other orthopedic surgery and neurosurgical procedures also exist as treatment options to minimize the effects of spasticity. While each procedure has its own strengths and weaknesses for treating spasticity, none of them completely eliminate spasticity in children.