Impact of specific symptoms of spasticity on voluntary lower limb muscle function, gait and daily activities during subacute and chronic spinal cord injury

Abstract

BACKGROUND: Although the spasticity syndrome is an important sensorimotor disorder, the impact of grade of lower limb muscle hypertonia, spasm and clonus activity on voluntary muscle function, gait and daily activities has not been systematically analysed during subacute and chronic spinal cord injury (SCI). OBJECTIVE: To determine the prevalence of spasticity signs and symptoms during SCI, and to assess their impact on motor function and activities. METHODS: A descriptive transverse study of sixty-six subjects with SCI was performed by assessing injury characteristics, spasticity (modified Ashworth scale, Penn scale, SCATS scale) and motor function (lower limb manual muscle scores, WISCI II, spinal cord injury spasticity evaluation tool). RESULTS: Most subjects with the spasticity syndrome presented lower limb hypertonia and spasms during both subacute and chronic SCI, interfering with daily life activities. Subjects with incomplete SCI and hypertonia revealed a loss of voluntary flexor muscle activity, while extensors spasms contributed strongly to loss of gait function. The Penn spasms scale no correlated with muscle function or gait. CONCLUSIONS: Specific diagnosis of spasm activity during subacute SCI, and its impact on lower limb voluntary muscle activity, gait function and daily activities, is required to develop a more effective neurorehabilitation treatment strategy.

Thoracic 9 Spinal Transection-Induced Model of Muscle Spasticity in the Rat: A Systematic Electrophysiological and Histopathological Characterization

“…The advantage of using a complete Th9 transection model appears to be its ability to recapitulate a multisegmental hyper-reflexia extending from lower thoracic to lumbo-sacral segments and its complexity in affecting equally large extensor and flexor muscle groups of the hindlimbs, i.e. characteristics seen in human patients with spinal trauma induced spasticity [ 2 , 52 , 53 ]. In addition from the perspective of development of new therapies based on spinal parenchymal or lumbar intrathecal cell or gene delivery the use of Th9 model appears to be advantageous in terms of providing more easily accessible intrathecal space and larger spinal parenchyma to perform segment-targeted injections.…”

“…It has been demonstrated, for example, that the potassium-chloride cotransporter KCC2 is downregulated in α-motoneuron membranes in spinally-injured rats. This leads to depolarization of the Cl- equilibrium potential and a reduction in strength of gamma-aminobutyric acid(A) (GABA A) and glycine receptor-mediated postsynaptic inhibition [ 2 , 52 , 53 ].…”

Spasticity in patients with traumatic spinal cord injury: from the patients’ and physicians’ perspective

“…They have recommended considering the beneficial effects when deciding on whether to treat spasticity. [26] Bravo-Esteban et al [27] have evaluated 66 SCI patients in the subacute and chronic stage with MAS, PSFS and the Spinal Cord Assessment Tool for Spastic reflexes (SCATS) and reported a harmful effect on ADL and walking functions. Johnson et al [28] evaluated the rate of considering the spasticity after SCI as a problem in the first, third and fifth years and found rates of 35%, 31% and 27%, respectively.…”

Impact of spasticity on functioning in spinal cord injury: an application of graphical modelling

“…The term "disabling spasticity" has been used when people perceive that spasticity limits their activities in daily life (8), and is therefore a target for intervention. Evidence pointing to the relationship between spasticity and functioning has shown significant interference with daily activities in people with more severe, self-reported spasticity compared with people with no or only mild spasticity (9). The impact of severe spasticity on body functions and structures and on performance in different daily activities is poorly documented.…”