b'With hyperreexia, pain is likely to be frommusclestotightenupmustbecountered muscle spasm. A stretch of a tight muscle triggerswith a regular stretching program. It is usually a reex spasm. For example, transferring frombest to discuss the specic stretches to be done a chair to bed involves straightening of the hips.with a medical provider, or perhaps with a This motion stretches the opposing musclesphysical or hand therapist. This ensures the responsible for bending the hip joint. Thisright stretches are performed using the right stretch may trigger a reex spasm. The limbtechnique.jerks into exion, locking up, often with a quick,The importance of keeping the limbs sharp pain. Our patient, Dan, described suchloose with a daily stretching program cannot pain as like a charley horse that doubles mebe overemphasized. There is no substitute for up until it lets go. Such spasms can cause aa regular stretch. Unfortunately, spasticity will host of problems, including muscle tears orcreep back quickly if the stretching program is inammation, skin shearing, falls, or injuryinterrupted. So, the stretching program should from striking a limb against another bodybe part of ones daily routine. Caregivers should part, furniture, or even against a caregiver.be trained to help with the stretching program Spasticitymayuctuateconsiderably.if it cannot be done solely by the individual. Factors such as pain, stress, bladder infection,Other holistic ways to deal with spasticity constipation, dehydration, and illness mayinclude yoga, massage, and muscle relaxation aggravate spasticity. Cold temperatures maytechniques. Walking, cycling, and other make muscles stiffer and spasticity worse.aerobic exercises help by providing rhythmic Heat may relieve spasticity, although it mightlengthening and shortening of limbs during make other symptoms worse.activity.Deetteeccttiioonnaannddmmaannaaggeemmeenntt Splinting and bracingsuch as wearing DTreating spasticity starts with detecting itsan overnight splint for the hand or anklepresence. In the clinic, we do so by testingwillprovideaprolongedstretchofastiff reexes, by moving limbs through passivemuscle. These modalities may help maintain range of motion to gauge muscle tone and byrangeofmotionandpreventcontracture. observing muscle activities such as walkingStanding frames can help those unable to and nger-to-nose testing. In todays world,stand independently. Elevating footrests on a more and more visits are being conductedwheelchair or recliner and good positioning remotely. It is hard to test reexes or to testin the bed can also be used for prolonged for abnormal muscle tone in a remote visit.stretching. Inthissetting,thepatientsdescriptionofMMeeddiiccaattiioonnssmuscle stiffness and muscle spasms helpsWhen it comes to medications, the goal is communicate the spasticity that is present.to use antispasticity drugs only as needed. If left unattended, spasticity usually worsensAll such drugs have the potential to cause over time. So, a spasticity management planside-effects, more so at higher doses. These is essential. First, eliminate possible triggers,drugs are used in combination with stretching such as poorly tting clothing, an overextendedand other strategies, but not in place of them. bladder, or any other physical stress on theThe most common medications for spasticity body. Secondly, the tendency for the spasticinclude baclofen, tizanidine, and gabapentin, 19 msfocusmagazine.org'