Functional hindrance due to spasticity in individuals with spinal cord injury during inpatient rehabilitation and 1 year thereafter

Abstract

Study design: Prospective cohort study. Objective: To assess functional hindrance due to spasticity during inpatient rehabilitation and 1 year thereafter in individuals with spinal cord injury (SCI) and to determine factors that influence the hindrance. Setting: Eight specialized rehabilitation centres in the Netherlands. Methods: A total of 203 patients with recent SCI rated the hindrance they perceived due to spasticity in daily living at the start of active rehabilitation (t1), 3 months later (t2), at discharge (t3) and 1 year after discharge (t4). Hindrance was dichotomized into absent or negligible and present. Multilevel regression analyses were performed to determine the course of functional hindrance due to spasticity and its associations with possible determinants-namely, age, gender, cause, lesion level, motor completeness, spasticity and anti-spasticity medication. Results: The percentage of individuals that indicated functional hindrance due to spasticity ranged from 54 to 62% over time and did not change significantly over time (Δt3t1 odds ratio (OR) = 0.85, P = 0.44; Δt3t2 OR = 1.20, P = 0.41; Δt3t4 OR = 0.91, P = 0.67). The percentage of individuals who experienced a lot of hindrance due to spasticity during specific activities ranged from 4 to 27%. The odds for experiencing functional hindrance due to spasticity were significantly higher for individuals with tetraplegia (OR = 2.17, P = 0.0001), more severe spasticity (OR = 5.51, Po0.0001) and for those using anti-spasticity medication (OR = 4.18, Po0.0001). INTRODUCTIONSpasticity is defined as 'disordered sensori-motor control, resulting from an upper motor neuron lesion, presenting as intermittent or sustained involuntary activation of muscles'. 1 The literature has shown that 65-78% of individuals with chronic spinal cord injury (SCI) have symptoms of spasticity. 2,3 It has the potential to negatively influence the quality of life through restricting activities of daily living, causing pain and contributing to the development of contractures. 4,5 In a sample of SCI survivors, the prevalence of problematic spasticity at 1, 3 and 5 years following SCI was 35%, 31% and 27%, respectively. 5 These findings agree with the observations of Levi et al. 6 and Sköld et al. 3 Adriaansen et al. 7 reported problematic spasticity in 28-34% of individuals with SCI 1-5 years after discharge from inpatient rehabilitation. However, these studies do not describe how hindrance due to spasticity develops in the early phase after SCI. More knowledge is necessary about the course of hindrance over time and which activities of daily living are most hindered by spasticity in order to improve the management of spasticity.The aim of the present study was to describe functional hindrance due to spasticity during inpatient rehabilitation and 1 year thereafter

A longitudinal study of self-reported spasticity among individuals with chronic spinal cord injury

“…While there was a significant increase in both the percentage of individuals with spasticity and the average reported severity of spasticity, there was no significant change in the percentage of individuals who used prescription medications for spasticity. We found that the majority of individuals (~55%) took prescription medications for spasticity, slightly higher than previous findings, which estimate 35-46% of persons with chronic SCI use prescription medications (e.g., baclofen, dantrolene, diazepam, or tizanidine) to manage their symptoms [6,17,19,23]. Considering the frequency of use, we found that roughly 9% of participants took their medications only sometimes or weekly.…”

“…Only a handful of prospective studies have assessed changes in spasticity, primarily focused on the first few years after injury [15,19,22,23]. In some studies, the prevalence was reported to decrease over time [18,[20][21][22], while others have found the odds of reporting spasticity to increase over time [24].…”

Voluntary Ambulation by Upper Limb-Triggered HAL® in Patients with Complete Quadri/Paraplegia Due to Chronic Spinal Cord Injury

“…Regarding the reduction of spasticity, we previously reported a decrease of mAs after HAL gait training for a patient with C4 SCI (Ikumi et al, 2017 ). Spasticity negatively influences quality of life for many SCI patients by causing pain, joint contracture, and restricted activity of daily living (Adams and Hicks, 2005 ; van Cooten et al, 2015 ). Therefore, this method may be useful to reduce spasticity and related concerns.…”

Does galvanic vestibular stimulation decrease spasticity in clinically complete spinal cord injury?

“…Spasticity is present in about 65% of patients with a traumatic spinal cord injury (SCI) at the time of rehabilitation discharge (Holtz et al, 2017) and increasing over time to 85% (Jorgensen et al, 2017;DiPiro et al, 2018). About 35-55% of SCI patients take some antispasticity medication (Holtz et al, 2017;DiPiro et al, 2018) and the majority report that the spasticity negatively affects daily functioning (van Cooten et al, 2015) and quality of life (Adams and Hicks, 2005). Many treatments exist for spasticity, including physical therapy modalities, pharmacological interventions, botulinum toxin injections, intrathecal drug delivery, and finally, surgery (Elbasiouny et al, 2010).…”