Spasticity; can it be prevented from

surfacing at all?


 By
 Rajul vasa
 Applied movement
scientist
 Mumbai [India]


www.brainstrokes.com

 Book description of spasticity.

Spasticity is described in medical books as a

resistance to passive movement in UMN (upper
motor neuron) disorder as a result of lesion in the
CNS (central nervous system)
Studies indicate that spasticity affects more than
half a million people in the United States alone,
and more than 12 million people worldwide.
Following stroke, approximately 65% of
individuals develop spasticity.
But, It is very important to consider patient’s
experiences of spasticity in their daily life and
experiences of therapists about spasticity in
clinical practice.

 What does the patient wants to know?
Medical service providers consider Spasticity
as an inevitable phenomenon once damage
is done to the brain. Whereas ………………

Stroke subject wants to get rid of it for good

and wonder why they experience such a
tightness despite all medical treatment.
Book definition does not interest patient. No
patient likes to hear that spasticity is
inevitable or to know that drug can only help
reduce spasticity.
 Distress to Frustration
 Stroke subjects feel helpless when arm comes in their way during
standing up, sitting down, walking and climbing and is not
under their control and does not move according to their desire.
 Stroke subjects get bothered when paretic arm remain closer to
the body on the chest, bent most of the time with difficulty to
reach out in open with the fingers fisting unable to open even
while bathing with thumb remaining in the palm all the time in
some people .
 Taking few steps is frustrating with foot turning in Supination and
heel rising within the shoe despite wearing orthotic splints.
Frustration mounts when walking demands constant attention at
the foot while placing it which otherwise they could take for
granted when normal.
 Toe clawing, great toe extension, bunion toes, difficulty in bending
the knee are also some of the constant challenges for many
with frustration mounting from constant fear of falling for simple
activities like standing and walking which is also highly
 Dark tunnel

When all the efforts fail to get rid of the

spasticity like relentless exercising,
taking expensive drugs, living with all
side effects of drugs and being jobless
frustrates many when no clear
direction is seen and no clear answer
to the problem is found.


One of the E mail [unedited] letters out of

many sent to me from around the world
speaks volume. [ Name of the patient and place is kept secret]
 E mail letter
Subject: How does one eliminate severe muscle spasticity after
acute thrombo embolic stroke without medication.

 “I have tried every muscle relaxant on the market, nothing

works. I have asked to be evaluated for Botox injections and I
was told not to expect any help from Botox. The distinct feeling
that I get from health professionals is to simply accept the
condition as permanent and not hope for any motor function
recovery. My stroke also afflicted me with epilepsy and it is
simply to dangerous to perform unsupervised physical therapy
with that neurological condition, I had a mild seizure on June 13
after nearly 18 months of normality. In any case I have a very
serious drop foot problem where I must drag my lower limb by
raising my hip in a completely unnatural manner. When health
specialists demonstrate such pessimistic attitudes how can a
stroke survivor demonstrate optimism? It is like someone
telling me, don’t worry and be happy you are still alive after all.
I am really starting to believe that in my case no amount of
hard work will ever pay dividends and provide some quality of
life improvement. Contd….
 E mail letter (continued)
 Post stroke depression is a real bitch and a serious bladder
control issue does not help at all. I don’t believe in miracles and
nothing I have seen in post stroke rehabilitation to date will
change my mind on the possibility of performing meaningful
post acute stroke recovery. How can you succeed where
thousands have failed before? If the Vasa Concept is as
effective as you claim, why is it not in use in all reputable stroke
rehab facilities? You seem to promote healing principles that
are more associated with the treatment of the energy centers of
the human body. Building new neuro muscular pathways to
healthy parts of the brain implies teaching the brain skills that
have been dormant for decades or have never been used at all.
What is the trigger mechanism capable of performing such a
reorganization of the brain. Triggered electro-myographywas
invented with the promise of helping stroke survivors rebuild
new neuro muscular pathways; it has proven nearly useless
with acute stroke survivors. Contd……
 E mail letter (continued)

Victims wishing to use E.M.G. must do so at their own expense
since insurance companies do not recognize it's benefit as a
therapeutic apparatus. Most stroke victims are already affected
by loss of revenue and must incur additional debt burden to seek
new rehabilitation therapies. Since money does not grow on trees,
very few have the possibility of seeking truly beneficial therapies
that might help to restore lost motor control functions. It really
comes down to how bad do you want to obtain medical treatment
and how much are you willing to spend to get rid of the
wheelchair permanently. In western society, stroke rehabilitation
is the domain of Physiatrists and they operate within a very rigid
frame of medical teaching in which holistic medicine has no
foundation or merit. We are not in a position to challenge what
the medical field considers to be it's imminent domain. We are
the patients and must often accept medical prognostics at face
value. If the physiatrists were the individuals afflicted by brain
attacks, I suspect that many of them would question traditional
teaching and seek help in uncharted territory. In a society where
healthcare is provided by the state. The state prefers to keep
medical expenditure per capita to a minimal. “
 Sincerely.
 Chaotic brain is made more chaotic.

Some patients even try oil massage, pigeon

blood massage, and any alternative
medicine in the hope to get rid of spasticity.
Acupuncture, acupressure and massage is
very good for a number of orthopedic
ailments but in neurological conditions like
stroke it can make the chaotic brain more
chaotic with externally induced sensory
inflow it cannot cope in presence of lesion.
 I feel time is up to look at the spasticity with
non traditional view to find its root cause and
of course it’s solution.

 What one must know
What one needs to know is that spasticity is
not a direct effect of lesion in the brain.
Immediate direct effect on muscle following
stroke is flaccidity and hypotonia.
Spasticity is triggered by self-organizing brain
with passage of time for a purpose [Rajul Vasa
unpublished observation].

Spasticity does recur despite all treatment as

long as purpose for its birth is not taken care
of in therapeutics. [Rajul Vasa unpublished observation]
One must remove the purpose to rid of the
spasticity permanently. [Rajul Vasa unpublished observation]

 Optimality of self-organized brain.
 I believe that spasticity is a product of
self-organizing brain in self defense to
prioritize safety following stroke. [Rajul Vasa
unpublished observation]
 Brain maintains one priority for all living organisms on this earth.
It is to prioritize safety of COM (centre of mass) at any cost.
 With paralysis safety of body is at stake as paretic body does not
have power to combat force of gravity and adds on to
disequilibrium.
 Spasticity is an optimal attempt of the self-organized brain to
offer increased resistance to move paretic body thereby
minimize instability and disequilibrium arising from flail paretic
segments with increased degrees of freedom that threatens
safety of COM. [Rajul Vasa unpublished observation]
 Spasticity also acts as a powerful “BRAKE” [Rajul Vasa unpublished
observation] on the fluid change in posture thereby avoiding
disequilibrium and optimizing and capitalizing on resistance to
 Clinically applied definition of spasticity in
Vasa Concept.

Prolonged activity of “spastic” muscles is
an endeavor of self organized stroke CNS
to restrict the increased degrees of
freedom of paretic flail segments with
continuous proactive anticipatory
contraction in chain of muscles [not reflex
contraction] to restrict the boundaries of
COM movement in different Cartesian
coordinates in self defense for; safety of
COM is always a priority for all living self
organizing biological system.



 Events that follow with stroke

 Paretic body mass without power in muscles to combat

gravitational force causes disequilibrium and poses threat
to the safety of COM.
 Self-organizing brain with instant plasticity switches control
on COM from paretic body to good body exclusively. For;
safety of COM is always a priority.
 With one side turning flail and paretic, the opposite good
side pulls on paretic side unopposed causing trunk to
rotate away from paretic side. This leads to unloading of
paretic lower limb from sustaining head arm trunk [HAT]
mass. [Large postural muscles of both sides of the trunk act like ONE CIRCULAR RING having
common insertion on central axis at the back and Linea alba in the front]
 With unloading of paretic lower limb, snowball effects on
paretic body [Mouth +Face + Trunk + upper limb + lower limb] , on quality of
speech, effects in distant distributed sensory, motor,
perceptual, cognitive and limbic areas of brain gets
triggered……….
 Neural endorsement of mechanical
Unloading of paretic Lower Limb.
 Self-organizing brain exploits unopposed mechanical
pull of good trunk muscles with its simultaneously
ongoing sensory inflow from reoriented and rotated
head arm trunk to neurally endorse mechanical
unloading of paretic lower limb from sustaining
passive inertial mass of head arm and trunk [HAT] in
order to reduce the threat to COM (centre of the mass) and
prioritize safety by reorganizing anticipatory
postural circuits to control and restore COM
exclusively with good side of the body and to make
it as an automatic act. [Rajul Vasa unpublished observation]


 This makes it almost impossible to reload the

paretic limb unless one takes care of control on COM
and restore COM with paretic limbs automatically
[Rajul Vasa unpublished observation] through therapeutics based
 Bilateral innervation of the trunk
I feel that….
Self-organizing brain might be exploiting
bilateral innervation of the trunk also to bind
anatomically connected paretic torso with
good torso at the central axis.
Reorganization of cerebello-cerebellar inter
connectivity might be helping to sustain
paretic trunk against the force of gravity
when standing.
Binding of paretic trunk to good trunk
mechanically with contracture might help to
sustain interactive disequilibriating forces
when lower limbs go in swing phase of the
gait cycle while walking.
 Binding of the torso at the central axis
I also feel that …
Self-organizing brain might be binding the paretic
torso to good torso in order to reduce threat to the
safety of COM from inertial mass of the paretic torso.
Self-organizing brain might be passively binding
paretic torso to central axis with contracture in deep
tissues and in small inter vertebral muscles to
strengthen egocentric reference for paretic good
side.
Self-organizing brain might be binding the paretic
torso with good torso in order to make the paretic
body to follow the good body, and to allow the good
body to lead uninterruptedly so that exchange of
dominance between two sides comes to an end to
prioritize safety of COM
 What does it lead to?

It leads to chain of unseen under currents that
gives birth to abnormal synergic grouping in
chain of muscles with spasticity to sacrifice
selective control.


 Paretic limbs unable to sustain force of gravity

reinvents its presence in 3 dimensional space
for gravicentric reference via good side of the
body by moving in one single direction, only
towards the central axis thereby strengthening
the egocentric reference of paretic limbs to
central axis [Rajul Vasa unpublished observation] from
physiological inter limb coupling and inter limb
sensation.
 Synergic grouping also enable the entire body to
work as one whole [Rajul Vasa unpublished observation]
entirely optimally integrated unit [though integrated
Birth of spasticity from walking with unloaded
lower limb
 In normal people during daily activities like standing up, sitting
down, walking and climbing all 4 limbs remain integrated and
tightly coupled with physiological inter limb sensation and
inter limb knowledge.
 For a stroke subject with paretic unloaded lower limb that no
longer control and restore COM also makes simultaneous
sensory afferent inflow to remain consistent and unchanging.
 Consistently unchanging imbalanced afferent inflow between
paretic and non paretic good side might be leading to
reorganization of spino-spinal circuits and supra spinal
postural circuits for automatic safety of COM with good side.
 Paretic upper limb tightly coupled with rest of the limbs comes
under heavy influence of paretic unloaded lower limb that no
longer controls or restores COM making upper limb to go in
abnormal looking flexion adduction posture or bent elbow
posture in order to not let the COM run out of the narrow
support surface.
 Physiological inter limb coupling

Normal physiological inter limb coupling enables

normal people to have swing of the arm when
both lower limbs are alternately responsible for
weight bearing and weight shifting of the inertial
mass of the head arm and trunk [HAT]during
walking with both sides of the body constantly
alternating to lead and to follow one another
highly subconsciously automatically without
thinking.
It is this coupling between the limbs that allow one
arm to reach out in open easily to pick things
when the other limbs are acting as a supporter of
the act to complete the act of reaching and
picking. Whereas In a stroke subject……


 Normal Lady
In a stroke subject, upper
Hopping on single limb goes in flexion posture
leg that can be compared with
normal inter limb coupling in
a normal woman seen in the
picture hopping on one leg
that can be compared with
reduced loading or unloading
of the paretic lower limb while
walking making abnormal
looking flexion posture to be
inevitable under the given
circumstances in stroke pts.
 Swinging of arms while walking.

Flexed abnormal synergic posture of

paretic UL in defense of COM from
unloading of paretic LL of HAT mass
prevents swing of arms that may
risk COM safety on narrow support
surface.
Abnormal Flexion synergy in UL
sacrifices volitional control for
safety of COM.

 In a stroke subject, upper limb
Flexed posture goes in flexion posture difficult
of upper limb. to change even with passive
external force.
Paretic UL treated individually
under direct focus in
multidisciplinary approach by a
specialist may result in; Mental
exclusion of paretic limbs from
being part of one whole during
postural activities of daily
living, this makes stroke as a
condition to become
permanent.
  Paretic unloaded LL sustains itself
Right knee against the force of gravity from
recurvatum
collapsing with force from bone
on bone locking with passive
recurvatum of the knee i.e. knee
joint locking on ligamentous
over stretching.
 Some patients also develop
exaggerated quadriceps activity
in knee extension that makes
lower limb act as a prop making
knee bending difficult.
 Leg as a prop helps to support the
[HAT] mass briefly when good
limb goes in swing phase of
walking with its consequences
on upper limb……
Looking down

Walking pattern
 Different Walking pattern emerges in
and walking. different stroke subjects .
 Looking down for safety feeling emerges
without their knowledge.
 Walking speed reduces greatly.
 Step length reduces and number of steps /
minute reduces.
 Balance becomes precarious and may need
external support of hemiwalker / cane /
crutch etc.
 Good body continues to lead the entire
body preventing any exchange of
dominance between two sides changing
complete rhythm of cyclical alternating
action of walking.
 Gait training has little effect on restoring
safety feeling or rhythmic cyclical
automatic action or on use of eyes for
balance.
 Egocentric and Gravicentric reference.

Paretic upper limb exaggerates its egocentric

reference for sustaining itself in gravitational
field by coming closer to central axis with
flexed adducted posture.
This adds onto, no swing of the arm.
Paretic body finds its gravicentric reference via
good body and gets mechanically towed to be
a constant follower of good side of the body.

“Normally abnormal, becomes normal”

“Normally abnormal, becomes normal” for the

stroke CNS with full stop on the exchange of
dominance between two sides of the body
making good side to “lead” always and
paretic side to always “follow” making stroke,
a condition forever with deterioration in
general condition with muscle to continue to
get tightened and get wasted though stroke
is not a progressive disorder.
 Contemporary management of
spasticity
Forced passive movement.
Inhibitory exercises. [Though spasticity do reappear after a while].
Splinting. [Passive sustained stretch from splint falls short to activate the Golgi tendon
making spastic muscle more spastic and contracted under sustained contraction].

Number of drugs are available in the market but

none promise to get rid of spasticity for good.
Spastic muscle may go under surgeon’s knife, but
it is not the permanent solution.
Spasticity management is directed more towards
goals in “passive” function, such as making it
easier to get the arm through a sleeve or to
maintain hygiene.

 Permanent solution in Vasa Concept
 I feel, manmade efforts become dwarf compared to
powerful purpose of self-organized brain to maintain
its priority unless….
Therapeutic efforts are directed towards maintaining
the same priority to control and restore COM with
paretic side of the body so that purpose for birth
of spasticity is removed for good.
Promote paretic body to lead entire body and make
good body to learn to follow the paretic body to
allow smooth exchange of dominance between
two sides of the body to lead and to follow on the
need of the moment automatically without
thinking and planning.
Restoration of exchange of dominance between

paretic and good side will not allow spasticity to

surface at all.
