Evidence of treating spasticity before it develops: a systematic review of spasticity outcomes in acute spinal cord injury interventional trials

Abstract

Introduction: Spasticity is a common consequence of spinal cord injury (SCI), estimated to affect up to 93% of people living with SCI in the community. Problematic spasticity affects around 35% people with SCI spasticity. The early period after injury is believed to be the most opportune time for neural plasticity after SCI. We hypothesize that clinical interventions in the early period could reduce the incidence of spasticity. To address this, we evaluated the spasticity outcomes of clinical trials with interventions early after SCI.Methods: We performed a systematic review of the literature between January 2000 and May 2021 to identify control trials, in humans and animals, that were performed early after SCI that included measures of spasticity in accordance with PRISMA guidelines.Results: Our search yielded 1,463 records of which we reviewed 852 abstracts and included 8 human trial peer-reviewed publications and 9 animal studies. The 9 animal trials largely supported the hypothesis that early intervention can reduce spasticity, including evidence from electrophysiological, behavioral, and histologic measures. Of the 8 human trials, only one study measured spasticity as a primary outcome with a sample size sufficient to test the hypothesis. In this study, neuromodulation of the spinal cord using electric stimulation of the common peroneal nerve reduced spasticity in the lower extremities compared to controls.Conclusion: Given the prevalence of problematic spasticity, there is surprisingly little research being performed in the early period of SCI that includes spasticity measures, and even fewer studies that directly address spasticity. More research on the potential for early interventions to mitigate spasticity is needed.

Management of acute cervical spinal cord injury in the non‐specialist intensive care unit: a narrative review of current evidence

“…reduction in risk of venous thrombosis [52]; helping with transfers [53]; and maintenance of muscle mass [54]), managing spasticity appropriately can reduce pain, spasms, involuntary movement, soft tissue shortening, contractures and skin damage, and ultimately may improve rehabilitation progress [55]. Early recognition and treatment of spasticity are therefore likely to be vital, but high‐quality research is lacking [56].…”

The Relationship Between Spasticity and Bone Mineral Density and Lean Body Mass in İndividuals with Spinal Cord Injury

“…5 Önceki çalışmalar, kronik SKY'li bireylerin %65-78'inin spastisiteyi tecrübe ettiğini ve yaklaşık %40'ının ise yaşam kalitesini düşüren spastisiteye sahip olduğunu bildirmiştir. [6][7][8] Spastisitenin olumsuz etkilerine rağmen ayakta durma ve günlük yaşam aktivitelerine yardımcı olma gibi bazı olumlu etkilerinin olduğu gösterilmiştir. 9,10 Spastisitenin kas kasılmasını artırması nedeni ile iskelet kas kitlesinde kayıpları önleyebileceğini ya da azaltabileceğini gösteren az sayıda çalışma yapılmıştır.…”