Spasticity Management after Spinal Cord Injury: The Here and Now

J. Pers. Med., 2022 · DOI: 10.3390/jpm12050808 · Published: May 17, 2022

Spinal Cord Injury Neurology Rehabilitation

Simple Explanation

Spasticity, common after spinal cord injury (SCI), involves increased muscle tone and spasms due to uncontrolled reflexes below the injury site. While sometimes helpful for functions like standing, it can also be painful and limit mobility. The nervous system uses reflexes to coordinate body movements. Damage to the central nervous system (CNS) disrupts this coordination, leading to spasticity. Understanding the interaction between the CNS and peripheral nervous system is key. Treatments range from managing triggers like infections or tight clothing to therapies, medications, nerve blocks, and surgery, aiming to improve function and quality of life for individuals with SCI.

Study Duration

Not specified

Participants

354 spinal cord injured individuals in one survey; 161 patients in Sweden in another

Evidence Level

Not specified

Key Findings

1
Problematic spasticity is most prevalent in cervical spinal cord injuries, particularly in incomplete injuries (ASIA grades B–D).
2
Reduced corticospinal activity is associated with higher levels of spasticity, indicating a link between brain connectivity and spasticity after SCI.
3
Unperceived noxious stimuli below the level of injury can trigger increased spasticity, highlighting the importance of identifying and removing these triggers.

Research Summary

Spasticity, a common symptom after spinal cord injury (SCI), can be both beneficial and detrimental. It arises from the loss of supraspinal modulation of muscle stretch reflexes and intrinsic changes in the spinal cord. Assessment involves detailed clinical history, physical examinations, and spasticity scales to determine appropriate treatment, which ranges from conservative management and therapeutic modalities to pharmacotherapy, neurolysis, and surgical options. Effective management requires a comprehensive understanding of spasticity's pathophysiology, triggers, and available treatments to optimize patient care and improve quality of life for individuals with SCI.

Practical Implications

Personalized Treatment

Tailor spasticity management to individual needs, considering both the benefits and drawbacks of spasticity for each patient's daily life and function.

Trigger Identification

Thoroughly investigate and address potential triggers of spasticity, such as infections, bowel issues, or skin problems, to reduce its severity.

Multimodal Approach

Employ a combination of conservative, pharmacological, and interventional treatments to effectively manage spasticity and improve patient outcomes.

Study Limitations

1
Short-lived efficacy of some therapeutic modalities.
2
Sedating qualities with action on the central nervous system of most pharmacologic spasticity treatment options
3
Variable duration of effect of Chemical neurolytics

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