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Pathophysiology of Spasticity Yoshihisa Masakado 1 1Department of Rehabilitation Medicine, Tokai University School of Medicine Keyword: pathophysiology(病態生理) , spasticity(痙縮) , tonic stretch reflex(緊張性伸張反射) , phasic stretch reflex(相動性伸長反射) pp.505-510
Published Date 2013/7/18
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Abstract : Spasticity is a frequent and often disabling feature of neurological disease encountered in Rehabilitation Medicine. The core feature of the spastic state is the exaggeration of stretch reflexes, which manifest as hypertonus. The stretch reflex threshold is reduced, and its gain may be increased. The result is a velocity-dependent increase in the resistance of a passively stretched muscle. Spasticity is traditionally ascribed to damage to the pyramidal tract. However, studies in animals clearly implicate additional motor tracts in the pathophysiology of spasticity. In cerebral lesions some of the drive on the inhibitory center in the caudal brainstem is lost resulting in a spastic hemiplegia. Partial spinal lesions usually involve the lateral corticospinal and dorsal reticulospinal tracts, as most commonly seen in multiple sclerosis. Investigations have been conducted to ascertain which alterations in spinal reflex transmission could be responsible for the increased stretch reflex activity. Many spinal reflex pathways may increase or decrease the effect of the monosynaptic excitation : muscle spindle group Ⅱ afferent, Ib inhibition, recurrent inhibition, presynaptic inhibition of Ia afferent terminals, reciprocal inhibition from muscle spindle Ia afferents from the antagonist muscles, fusimotor drive, post activation depression, plateau potentials, etc. Many of the factors mentioned above may contribute differently to the degree of the spasticity, depending on the location of the lesion (spinal or cerebral), disease, the extent of the lesion, etc. Gaining a more detailed understanding of the mechanisms underlying the development of spasticity will increase the possibilities of developing more optimal and differentiated methods of treatment and rehabilitation.


Copyright © 2013, The Japanese Association of Rehabilitation Medicine. All rights reserved.

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電子版ISSN 印刷版ISSN 1881-3526 日本リハビリテーション医学会

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