Post-Stroke Spasticity: Best Treatment Options

Spasticity occurs due to damage to the brain or the spinal cord (upper motor neuron). It causes involuntary muscle contractions due to hyperexcitability of the stretch reflex. You can manage this problem conservatively including stretching, and movement retraining. However, when spasticity is moderate to severe, it may require medical interventions including medication, injections, and/or surgery.
Medication
1. Baclofen
2. Alpha 2 Agonist
3. Anticonvulsants
4. Muscle relaxers
Injections
1. Botulin toxin
Surgery
1. Baclofen pump implantation
2. Tendon transfer
3. Joint fusions
4. Tendon lengthening
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[@lynnecameron6645]

Thank you this is very informative. I had Botox into Pec Minor as the spacticity was subluxing my shoulder. It has helped enormously to the extent that I am now able to strengthen stability muscles around the shoulder joint.

[@rehabhqofficial]

That is great! Thank you for sharing. i am going to pin this so others can see an example of how botox can be used to help with stroke recovery : )

[@yganoks48]

If the botox works, why my neuro surgeon doesn't allow me to try it to my left arm. I have shoulder subluxation too.

[@rehabhqofficial]

@@yganoks48 that is a great question. If you have a subluxation, you may not have spasticity. That is just a thought :) I would ask your neurosurgeon or maybe seek a second opinion from a physiatrist :)

[@GdUpG2Gmafia]

Can muscles that been injected with botox still able to be reconnected to the brain, to regain fiction of the affected limb?

[@shirisha5038]

@@rehabhqofficial mam my name is shirisha I have a walking problem.. I walk ony toes.. What is the prblm of my legs.. It's spasticity or muscle weakness.. Pls help me mam.. Plss givee me sugesstion mam

[@pelicanformation3802]

As a student Podiatrist, I am learning heaps from you. Thank you.

[@mariemedeiros5672]

I've been having botox treatment on my arm, & shoulder muscles to help with spasticity in fingers, bicep, etc. for over 5 years. it has been life changing in combination with stretching & exercising. In time, dosage got reduced as well as frequency. Botox enabled me to relax enough to be able to strengthen the muscles to fight the spasticity on its own.

[@tamiroupp2075]

I stumbled upon this when looking for best medication reviews for spasticity pain. I’m an OT, and was surprised and happy to find this video. You explain the medical spasticity options very well, and I’ll be sharing your video with my patients! Thanks!

[@yganoks48]

Thank you, dr. Tara tobias for helping us. I love the quotation behind you... DO YOUR BEST NEVER GIVE UP.

[@lidiapalomino2085]

Thank you so much for the info. I have learned a lot I did not know on nerve medications effects between the muscles and nerves and a Physiatrist specialist. Jehovah God bless you from sharing your medical talent to the public.

[@caitlinadalton]

Yes. JEHOVAH GOD. thank you 😊

[@LifewheelsJoy]

I am one of the Jehovah's witnesses too 😘 ive had spasticity since 2019

[@jes587690]

Great video explaining a lot of vital information, thank you, I'm going to try and find me a physiatrists doctor, hope it will help me to maintain.

[@ChazTagg]

Thank you for educating me and very honestly :) I LOVE your videos and have referred many fellow stroke warriors to your channel :)

[@rehabhqofficial]

Thanks for watching, for commenting and for sharing :) I hope it is helping :)

[@brucebehmke]

Thank you 🙏 I have learned more from your videos than any others an I have watched a ton ! I was first diagnosed with chronic Lyme’s disease about 18 months ago hands and feet became very numb and tingly could not walk without a walker. Within four months was diagnosed with cervical stenosis and had a operation at Jefferson Hospital in Philadelphia where they put the rods in the screws ! It’s been 13 months since that operation and still have limited use of hands and feet ! These symptoms that I have seem like a stroke MS, lupus,nerve or spinal damage but I can’t get a doctor to make another diagnosis ! I have been following your exercises and becoming more mobile ! So I never make comments but this is tell to you that you are making a great impact on my life ❣️ Bruce Behmke 68 yrs

[@fepunsalan2117]

Doc.gud eve..im your follower and ido excercises that you..give for my spasticity is gone thank you very much doc..for now ineed excercises to improve my ealking faster i used sa quad cane..your the great doctor theraphy..thank you very much doc.keep up the good work godbless you...

[@indaskies3134]

I had bad spasticity in the arm and leg. 3 years post stroke and the spasticity has nearly left the leg, hence my walking is returning to a more normalized gait. I'm still receiving botox in my arm.

[@robertpage8469]

Was there anything particular you feel that helped with your recovery, the spasticity nearly leaving the leg?

[@lynnmorrison]

3 years into my Stroke. Up to 1/8/2023, I had no problem with my stroke arm or hand; I could move them both, I just can't pick something with my fingers or hold something. Then all of the sudden my muscles and hand just tightened up like a stiff rubber band.

[@raulruizruiz9608]

I am far out from my stroke and worried if it's too late for Botox and a legitimate rehab facility that offers all the help I will need and only learning now how Botox can help with my severe spastic muscles. I'm excited to get started.

[@tarjitkaur8256]

hiiii.u explain veey nicely .plz make video on multiple sclerosis patients

[@rehabhqofficial]

Thanks for watching! Anything specific related to multiple sclerosis that you would like explained?

[@debsh6346]

After my elective surgery I had a stroke. Several other patients in Rehab had a similar experience. No one warned me this was a risk of elective surgery.

[@rehabhqofficial]

Thanks for sharing! Many risks involved with any elective surgery.

[@rebeccafinch9361]

I have been on Trazadone 100 mg per night for about 20 years. In June of 2020 I got a prescription for Baclofen 5 mg three times per day. My understanding now is that these are drugs with anti-cholinergic effects that block the action of the neurotransmitter acetycholine, which is necessary for laying down long term memories in the brain. I do not have any of the symptoms generally associated with anti-cholinergic reactions (dizziness, dry mouth, drowsiness, falls, confusion, constipation) but I am wondering if these medications do, in fact, interfere with brain rewiring. Will appreciate any ideas you may have on the subject,

[@wendyoloff5944]

Thank you for explaining their effects! I need to stretch more!

[@rehabhqofficial]

Thanks for watching! Yes, stretching is important :)

[@jheneal052210]

thank you dr. Tobias, i well take the long term medication insted of taking the short-cut but i well benifits the good posture of my body❤❤❤

[@caitlinadalton]

Very good advice. Thank you!!

[@sylviaortiz4224]

Thank you! Your videos are so informative. On the surgeries that you mentioned, what type of Dr would we need to see if we were considering it for ankle/foot spasticity? Would it be an orthopedic or a podiatrist?

[@jihadhaddadin1586]

Thank you Doctor ,got it

[@melaniejo5296]

Do you ever use TENS/EMS for flexion contracture?

[@luisequevedo2162]

Thank you for your help good bless you

[@hghuser]

Thank you for your videos; they have been very helpful. Just a question regarding spastic symptoms in foot ; is there a way to relieve pain when using a afo, training to walk/ standing.Have Been wheelchair bound for over 25 years due to epilepsy; medication and seizure free for over 15 years but nerve pain and spasms have slowing my progress to walking again. thanks in advance.

[@jihadhaddadin1586]

Thank you so much Doctor

[@rehabhqofficial]

Thanks for watching! I hope it helps :)

[@yaronkl]

thank you! very good video

[@jacquelinehuntington5695]

Great information.

[@raulruizruiz9608]

Is it ever too late to get help with post stroke spasticity or high tone??

[@themartyd]

surely repettative exercise of the spastic muscle is the best option to rehain function???

[@rehabhqofficial]

yes, in addition to other things I talk about in this video😊

[@alanjohnson2613]

Tried botox for awhile stopped as too expensive to continue. Therapist worked out of same office as the doctor prescribing the botox

[@mui25]

How much is botox cost?

[@jamesshanklin6036]

I had a stroke 4 years ago, when I walk my foot flares out. What exercises can I do to stop it?

[@noreensanchez4170]

Doc does it mean that spasticity is permanent though you're doing stretching, strengthening, exercising and medication?

[@Rstcom]

I need to see the Hip drops video

[@jesselynardiente9667]

Thank you.. ❤️🙏❤️

[@mrstevek118]

I have severe spasticity and have had Botox injections in some areas

[@mui25]

How much is botox,does it work for you?

[@alanjohnson2613]

Tried the baclofin for a long time, stopped because did not seem to have any affect

[@nigelprice3929]

Hi Alan, I am in the same position right now re baclofen. Could I ask you how did you work out what new medication to try next ? Many thanks nigel

[@henrybudziarski4404]

I’ve just been trying to find out about stem cells to get my memory working and my muscle strength, The doctor been telling me it’s trying to work for trials for five years, been telling me every year and now it’s been 10 years now and I’m still waiting to see him.. and I’ll what happens 🤷🏽‍♂️ ... he got to say this time ??

[@lydiaalpad7383]

I been on stroke rehabilitation and still have spacity in core area,I still not carry my weights. I can't move from bed to stand. Hope to hel0 me. I have thick saliva to get rid off thank you

[@mui25]

I guarantee you if you can try Dr Edward Tobinick in Florida you gonna have your memory and congnition back immediately. Try INR in Bacon Raton

[@stevedennis2518]

I see a study where surgeons fixed the scapula to the spine to stop winging 😮🤦🏻‍♂️

[@kevinpm2533]

Reading with my reading cheaters sets of my spasms to extreme levels. Any thoughts

[@TheAdhdGardener]

This was good info. I have MS and with that is chronic spasticity. Oh those muscle spasms my goodness 😳 talk about pain! Baclofen n Xanaflex did absolutely Nothing for me at all. My only other option was some heart med that "worked" for spasms. I didn't take it well I don't have heart problems🤷‍♀️ if my spasms are literally my entire back would I need multiple back injections? That in itself sounds super painful.

[@TheAdhdGardener]

@@garywalling4341 DAMN!!😳 I'm assuming if you're going back the botox worked. How long did it last for?

[@TheAdhdGardener]

@@garywalling4341 😔 man I feel ya. The really painful spasms I get are on my back. Oh gosh the pain is terrible despite a high pain threshold. I be walking like an robot! Medical cannabis was the only thing at being even remotely effective for spasms. It can help alleviate and take the edge off the pain. Id suggest in all form n mix n match to help vying the most relief. Hopefully u find relief🌻🌻

[@lilmamadrea87]

i think i found the answer that i was looking for seizures botox and exercises and watching your other videos yes the more i exercised the more seizures i had which caused me to quit rehab and im scared to do botox becausev i think my seizures will get worse.

[@powgan1556]

CBD can help seziures. Google it.

[@reginaturner8250]

I had a stroke 2 months ago. Within 2 weeks I began to have muscle tightness in the affected arm that worsened over time. My fingers on that side also became stiff and painful. An MRI was completed which revealed a small tear in my rotator cuff which may have happened after I fell during the stroke. I decided to invest in weekly massages. I noticed in one of your vids you stated overstimulation of the spastic area is not recommended. Would you recommend discontinuing the massages?

[@alanjohnson2613]

Thought about baclofin pump but additional surgery was a no-go

[@rehabhqofficial]

I think baclofen pump should be a last resort for the reason you stated. Anything foreign in the body comes with a risk.

[@marlouiereyes6187]

I'm I'm 31 yrs old I can't open my hand how long it will takes for me to open my hand anthank you.

[@mui25]

It takes time, just hang in there and 🙏. Only God heals. Try saeboflex it will help. Don't give up! Its a journey

[@victormodesto9545]

Name of a medication by any chance

[@atauiliili6530]

My speech was lost when I had my stroke. Is there anything I need to do to get back my speech? I am reading all the time it's still the same it's frustrating.

[@rehabhqofficial]

I am not a speech therapist. This is something where speech therapy could really help because they can identify the exact reason why you can not talk. One general suggestion might be to read out loud, record it, listen to it and try and make corrections.

[@honeydsa1454]

@ A Tauiliili I started by trying to gulp to work those vocal muscles along with some mouth/tongue exercises. Also, try to make different sounds, like a baby does. Eventually it helps regain speech. Worked for me (stroke at 35yrs of age). Always a good idea to consult a speech therapist for your particular condition though

[@banterjojo6306]

For me Calcium didnt do anything. Botox doesn't even last 3 months 🙄 medication is not realistic for my life style. Surgery seems like my only hope at this point.

[@ariskiaznor7673]

Can exercise alone cure spasticm because ibotox injection ans surgeon are not avalaible in my country

[@edgardojusay4340]

Dr. Another problem of mine is when I am to move my bowel. As I am constipated after my stroke, I do not have a normal feeling ofl push. I have to force it hard and my toes curled and my fingers clenched so hard. Any suggestion Dr Tara. Please help. Thank you

[@garybersin4133]

I do not have any pain with my spasisity. I only have a problem walking without a walker or a cane. I really do not know how my falling caused my spasisity but I do know when I try to walk without s cane or walker I get a sense of fear of falling. I never had pain when I try to walk without a walker or cane .

[@rehabhqofficial]

Hi Gary! Thank you for watching and for sharing your story.

[@marlouiereyes6187]

hi celebrolycin can help for spasticity????

[@mrstevek118]

Am I going to have spasticity for the rest of my life

[@cathyhendrix5401]

Can you spell the doctor you mentioned

[@rehabhqofficial]

They are called physiatrists or physical medicine and rehab doctor

[@robertedwards909]

Can you cover clon a s

[@hayahhayah504]

3:20 where video starts

[@Lionessa8]

Would Botox Injections in a Spastic Shoulder, Arm, Wrist and Hand need to be administered by a Neuro Therapist? I haven't been able to find a Neuro Therapist in my home Island of Mallorca for my son. My son didn't have a stroke, but he had an Acute Subdural Hematoma when he was 4 months old, and they strapped his right arm and hand with bandages for weeks so that he would not pull out his tubes, which between that strapping and the brain injury left his right arm weak, smaller, and somewhat spastic from the shoulder to the hand. Can my son use the months that the botox is most effective to strengthen that arm and hand with exercises, or gym? And will that then help with long term positive changes?

[@GdUpG2Gmafia]

What about devices like e stim etc?

[@rehabhqofficial]

watch the videos in the description :)

[@GdUpG2Gmafia]

@@rehabhqofficial I don't see any videos on e stim!

[@virtuosoproductions4589]

I was told that you have to allocate large part of the brain to the spastic limb. Means, repetition of various kind of exercises to strengthen and increase ROM. Btw, doesn't last stage of brunnstorm says at sixth of recovery the spasticity disappears?

[@rehabhqofficial]

virtuoso Productions all true. Yes, final stage of motor recovery is coordinated movement. Meaning muscles can work together to coordinate movement

[@faisalahmad3309]

No cure with out side effects

[@jihadhaddadin1586]

To manege sizuer is the best is Keppra ,no side effects ,they give it to me because I had AVM, for many years ago

[@jenniferwu2731]

want to add that zanaflex made me pee every 30 minutes at night when i was in the hospital bc it was relaxing my bladder muscles lol

[@chrisspurney4208]

Hi I’m chris😂

[@smokeyization]

Ex heroin addict. Don't show me a 3ml syringe hahah.

[@janetfry2606]

You’re not a medical doctor. Stop giving medical advise.

[@tamiroupp2075]

She’s a PT - a rehab professional working intimately and extensively with patients and their MDs addressing the spasticity. I’m an OT - and in the same position as she is. She qualified herself at the beginning of the video. Listen more closely before you criticize.

[@CA-hl4hi]

I've been having botox treatment on my arm, & shoulder muscles to help with spasticity in fingers, bicep, etc. for over 5 years. it has been life changing in combination with stretching & exercising. In time, dosage got reduced as well as frequency. Botox enabled me to relax enough to be able to strengthen the muscles to fight the spasticity on its own.