Paralysis refers to the complete or partial loss of muscle function. A neurological injury such as stroke or spinal cord injury can cause paralysis including spastic paralysis (increased muscle tone) and flaccid paralysis (reduced muscle tone). Knowing how to distinguish between spastic vs flaccid paralysis is important in order to receive proper treatment and maximize the chances of recovery.
This article will differentiate spastic vs flaccid paralysis and discuss the best methods to promote movement in the affected muscles.
What Causes Paralysis?
To understand the difference between spastic vs. flaccid paralysis, it first helps to understand how the motor nervous system works.
The nervous system consists of the central nervous system (CNS) and the peripheral nervous system (PNS). The central nervous system includes the brain and spinal cord, which are the planning, coordinating, and organizing centers that control most of our daily activities.
The central nervous system also inhibits any overactivity from the peripheral nervous system which includes the anterior horn cells, ventral roots, and peripheral nerves. It is responsible for receiving messages from the CNS and executing the functions.
Motor neurons are also components of the nervous system that create complex circuits throughout the body. They are responsible for both voluntary and involuntary movement.
Upper motor neurons travel down from the brain to the spinal cord. Damage to the upper motor neurons can cause muscle stiffness or spasticity. Lower motor neurons begin in the spinal cord and travel throughout the body. Damage to lower motor neurons can cause weakness, loss of muscle, and twitching.
When certain parts of the nervous system become damaged such as the peripheral nerves, spinal cord, motor neurons, or brain, it can result in spastic or flaccid paralysis.
Paralysis refers to the loss of motor function in one or multiple parts of the body. It can develop due to many conditions that affect the nervous system such as multiple sclerosis, cerebral palsy, or traumatic brain injury. Studies have shown that the leading causes of paralysis are stroke with 33.7% of paralysis cases, followed by spinal cord injury with 27.3% of paralysis cases.
Paralysis after a stroke occurs when areas of the brain responsible for motor control become damaged. Each hemisphere of the brain controls movement on the opposite side of the body. Therefore, when a stroke causes paralysis, it leads to hemiplegia, or paralysis on the right or left side of the body.
Paralysis after a spinal cord injury occurs when the spinal cord is affected and the nerves can no longer send signals to the brain. This can cause paraplegia (paralysis in the lower limbs) or quadriplegia (paralysis in all four limbs).
Depending on the severity of the stroke or spinal cord injury, survivors may experience spastic or flaccid paralysis.
Differentiating Between Spastic vs Flaccid Paralysis
Though spastic paralysis and flaccid paralysis are both neurological disorders that interfere with correct muscle movement, they are two highly distinct types of paralysis. One key difference is that in flaccid paralysis, the muscles cannot contract and as a result become immobile and floppy. Whereas in spastic paralysis, the muscles remain in constant contraction and become rigid and immobile.
Flaccid paralysis can occur when the lower motor neurons become damaged, not allowing nerve impulses to reach the intended muscles. There is no voluntary control of the muscles in flaccid paralysis but there isn’t any involuntary control either, meaning the muscles don’t act at all. Flaccid paralysis reduces muscle tone, the amount of tension or resistance to movement in the muscle. It also causes muscles to shrink and become loose or flabby.
Spastic paralysis can occur when the upper motor neurons become damaged causing uncontrolled activities within the nervous system, this means there is no voluntary control of the muscles. With spastic paralysis, spinal neurons remain intact and the muscles are stimulated regularly. However, muscle tone involuntarily increases with spastic paralysis making the muscles tight and hard. As a result, survivors may experience muscle stiffness, spasms, or uncontrollable twitching.
Spastic paralysis and flaccid paralysis each have unique characterictis. Learning how to differentiate them is important in order to receive proper treatment.
How Passive Exercises Can Help Improve Spastic and Flaccid Paralysis
Damage from a neurological injury can affect the neural pathways within the nervous system, resulting in spastic or flaccid paralysis. To strengthen the existing neural connections and create new ones, neuroplasticity must be activated.
Neuroplasticity is the nervous system’s ability to heal and rewire itself. Restoring connections means better communication between the nervous system and the muscles. This helps maximize the chances of restoring movement and improving paralysis.
Neuroplasticity is best activated through massed practice, or high repetition of exercises. The more a certain skill is performed, the more the nervous system will recognize its importance and restore neural pathways for that skill.
The best way to exercise if you have limited or no mobility is with passive exercise. While active exercises are performed using your own energy, passive exercises involve assistance from your unaffected limbs or the help of a trained caregiver or therapist.
Even if you cannot move your muscles yourself, passive-assisted exercises help send signals to the nervous system to stimulate neuroplasticity, which is essential for spastic and flaccid paralysis rehabilitation.
Treating Spastic vs Flaccid Paralysis
Treatment for spastic vs flaccid paralysis may vary depending on the severity. However, both are equally necessary to treat in a timely manner in order to prevent further injury or complications.
If flaccid paralysis is left untreated, the muscles can begin to atrophy (reduce in size and waste away). If spastic paralysis is left untreated, it can lead to frozen joints, shortened tendons and limbs that can no longer be stretched out.
More serious complications can also develop if paralysis is neglected such as contractures or pressure sores on the skin. To reduce the chances of spastic and flaccid paralysis from worsening or developing serious complications, it’s crucial to have a suitable rehabilitation exercise plan.
This can include a combination of therapy exercises for spastic and flaccid paralysis such as:
- Passive Exercise: stimulates the nervous system and activates neuroplasticity. Most rehab exercises can be converted into passive exercises with the help of your unaffected limbs or a therapist.
- Range of Motion Exercise: focuses on moving your joints through their full range of motion. This is especially helpful for spastic paralysis to help prevent contractures and pressure sores, increase muscle flexibility, and reduce muscle stiffness and spasticity. Individuals with flaccid paralysis can also benefit from ROM exercises.
- Physical Therapy Exercise: focuses on improving functional mobility in the affected muscles through targeted exercises. Movement is crucial to stimulate the nervous system, prevent muscle atrophy, and lower the risk of other complications from paralysis.
- Occupational Therapy Exercise: focuses on restorative and compensatory strategies to perform daily activities and maximize independence. Daily activities can become challenging with spastic or flaccid paralysis but there are many effective occupational therapy exercises that can help you accomplish your daily goals, such as turning a light switch on and off. Adaptive equipment can also be helpful when using your unaffected muscles to eat or bathe.
- Home Therapy Exercise: focuses on motivating you to achieve high repetition of exercises and stimulate neuroplasticity in between your outpatient therapy sessions. Along with exercise sheets, home therapy may include neurorehabilitation devices such as FitMi and MusicGlove, which can be used passively to help improve flaccid and spastic paralysis.
Along with paralysis recovery exercises, some individuals may benefit from other types of treatment. Depending on the severity of paralysis, this can include:
- Medication: Secondary complications of paralysis such as pain and depression can interfere with the motivation needed to pursue rehabilitation. To help reduce pain and/or depression doctors may prescribe pain relievers or antidepressants. They may also prescribe muscle relaxants for spastic paralysis due to the high increase in muscle tone.
- Botox: Botulinum toxin, or botox, helps treat spasticity and relax stiff muscles, and therefore may be helpful with spastic paralysis but not with flaccid paralysis. It works by blocking the nerve impulses that cause muscles to involuntarily contract.
- Surgery: Studies have shown that advanced nerve surgery techniques alongside physical therapy may help treat paralysis after a spinal cord injury, particularly in the hands and arms. This is a highly invasive procedure and should only be considered when all other treatments have been exhausted.
- Electrical Stimulation: This is a promising treatment for flaccid and spastic paralysis. It involves placing electrodes on the surface of the skin over the affected muscles where a therapist will then apply electrical stimulation while controlling the strength and frequency using a device. Electrical impulses help the muscles contract and promote movement. Studies have shown that electrical stimulation combined with rehab exercise is even more effective than rehab exercise alone.
- Electroacupuncture: This is a combination of acupuncture and electrical stimulation. It works by inserting thin needles into specific points on your body and then electrical stimulation is gently applied to the needles. The more stimulation your body receives, the more it can help activate the nervous system and promote movement in your muscles.
Electrical stimulation and electroacupuncture are most effective when combined with therapy exercises. Speak to your therapist to learn what treatment combination is safe and suitable for your condition.
Understanding Spastic vs Flaccid Paralysis
Stroke and spinal cord injury are the two leading causes of paralysis. Differentiating between spastic vs flaccid paralysis is important in order to obtain a proper rehabilitation plan. Your combination of treatments may vary depending on the type and severity of your paralysis. However, all individuals can benefit from passive exercises that help stimulate the nervous system and activate neuroplasticity.
We hope this article has helped you understand how spastic vs. flaccid paralysis can develop and encouraged you to find a suitable home therapy exercise regimen.
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