Spasticity versus Rigidity (Stanford 25 Skills Symposium, 2015)

April 5, 2016

Can you differentiate between spasticity versus rigidity?

This is our first video release from our 2015 Stanford 25 Skills Symposium. This video is a part of a larger group of videos that were created during the symposium. In this short excerpt, Dr. Steve McGee talks about the approach to differentiating spasticity versus rigidity at the bedside.

 

When ever there is resistance to movement, think of the two most common issues: spasticity and rigidity. Both spasticity and rigidity represent hypertonic states, however both have different causes and characteristics that are important to be aware of.  (Of note a third cause of hypertonia is paratonia seen in anxious  or demented patients and sometimes the hypertonia is decreased with the patient is distracted during movement.)

Spasticity:

  • Caused by lesions in the pyramidal tract (i.e. upper motor neurons) such the corticospinal tract
    • Stroke
    • Spinal cord compression
    • Motor neuron disease
  • Weakness present
  • More resistance in one direction the other direction
  • More tone in initial part of movement – “Clasp knife spasticity”
  • It is velocity dependent  (i.e. more noticeable with fast movements)

Rigidity:

  • Seen in extrapyramidal lesions (i.e. Parkinson’s) is such as the rubrospinal or vestibulospinal tracts
  • Subtypes include:
    • Cog wheel rigidity (Parkinson’s) – Tremor superimposed on this hypertonia that results in intermittent increase in tone during the movement.
    • Lead pipe rigidity (neuroleptant malignant syndrome or less commonly stiff man syndrome) – Uniform increase in tone
  • Same resistance in all directions
  • Not velocity dependent – does not vary with speed of movement of muscle groups involved

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