Lower Extremity Manifestations of Spasticity in Chronic Spinal Cord Injury

Little, James W.; Micklesen, Paula J.; Umlauf, Robert L.; Britell, Catherine W.

doi:10.1097/00002060-198902000-00009

Cited by 126 publications

(112 citation statements)

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“…These two groups of activities partially overlap, as part of the perceived spasticity during transfers is possibly elicited by changing position. Other explanations for perceived spasticity during transfers are touching the skin, increasing 17,18 The influence of knee joint rotation in provoking extensor spasms is also described. 18 In addition to skin stimuli, imposed movements of the ankle or knee joint can also elicit flexor reflexes in SCI.…”

Section: Discussionmentioning

confidence: 99%

Perception of lower limb spasticity in patients with spinal cord injury

et al. 2008

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Study design: Cross-sectional study. Objective: To study the manifestation of spasticity in daily life of the patients with spinal cord injury, their perception of spasticity and spasticity-related discomfort. Setting: Rehabilitation center in the Netherlands. Methods: Twenty-six patients with motor complete spinal cord injury (SCI) and spasticity in the lower limbs completed a questionnaire. The following outcome measures were used: manifestation of spasticity, activities during which spasticity occurs, perceived degree of spasticity and resulting discomfort, measured with visual analog scale (VAS) and Borg scale, respectively. Results: In general, spasticity manifested as extensor spasms (84.6%), flexor spasms and/or clonus (both 69.2%), and less often as continuous tension (57.7%). The registered activities were categorized into five main groups: 'changing position' was the largest group (22.0%) with a median VAS of 6.8 (range: 2.5-9.5) and median Borg scale of 3.0 (range: 1.0-7.0). Other groups of activities were 'making a transfer' (20.7%), 'activities of daily living' (17.1%), 'being active' (17.1%) and 'stable body position' (12.2%). The overall correlation between VAS and Borg was moderate (Spearman's rho ¼ 0.53, P ¼ 0.005). Conclusions: Patients with complete SCI experienced several manifestations of spasticity, extensor spasms being the most common. Many daily life activities elicited different manifestations of spasticity. The experienced discomfort was only moderately related to the perceived degree of spasticity during an activity. Possibly, the discomfort is influenced by other factors than the perceived spasticity alone.

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Section: Discussionmentioning

confidence: 99%

Perception of lower limb spasticity in patients with spinal cord injury

et al. 2008

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“…41 However, the transmitted sensori-motor information is often fragmentary or distorted due to the alteration of the synaptic zone, 22,25,31,32 leading to clinical complications such as pain or spasticity. Little et al 42 reported that patients with incomplete lesions were more severely affected by spasticity with respect to functional mobility, sleep and pain, when compared to patients with complete lesions. Consequently, they displayed decreased range of motion either directly due to hypertonus or indirectly due to hypertonus-induced contracture.…”

Section: Differential Impact Of Complete and Incomplete Scimentioning

confidence: 99%

Reflex reciprocal facilitation of antagonist muscles in spinal cord injury

Xia

Rymer

2004

Spinal Cord

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Study Design: Electromyographic study in complete and incomplete spinal cord injury (SCI). Objective: To examine the changes in the pattern of reciprocal inhibition between agonist and antagonist muscles in SCI. Settings: Sensory Motor Performance Program, Rehabilitation Institute of Chicago, IL, USA. Methods: Tendon taps were delivered manually with an instrumented hammer to the tendons of the tibialis anterior and soleus muscle in positions of full-ankle dorsiflexion and plantarflexion in eight subjects with complete SCI and eight subjects with incomplete SCI. Electromyographic activity (EMG) was recorded from ankle dorsiflexor and plantarflexor muscles. Tapping force was also recorded by a force sensor mounted to the tendon hammer, indicating the stimulus onset. Measures of reflex EMG magnitude and reflex latency were obtained for both agonist and antagonist muscles. The ratio of antagonist to agonist EMG was computed based on normalized EMG. Results: Substantial reflex responses occurred in both the stretched muscle and in its antagonist. The reflex in antagonist, which we term 'reciprocal facilitation (RF)', was most evident in subjects with incomplete SCI. The magnitude of RF was consistently greater than reflex responses in agonist muscles under all test conditions. The latency of the RF was comparable to that of monosynaptic reflex response. Conclusions: Following SCI, reciprocal organization of segmental reflexes at the ankle is often partially or completely suppressed, allowing reflex activation in antagonist muscles to be manifested. Possible mechanisms underlying these changes in neural organization are discussed.

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“…Spasticity may increase the risk of falls during ADL such as transfers, wheelchair re-seating after a fall, and repositioning of the lower extremities. Little et al 40 reported that individuals with incomplete SCI lesions had more pain and more frequent spasticity interfering with ADL than patients with complete lesions. Lower extremity spasticity may increase both UE mechanical stress and physical strain during transfers.…”

Section: Previous Upper Extremity Injury or Diseasementioning

confidence: 99%

Preserving transfer independence among individuals with spinal cord injury

et al. 2000

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Study design: Literature review. Objectives: Upper extremity (UE) joint degeneration, particularly at the shoulder, detrimentally in¯uences functional independence, quality of life, cardiovascular disease risk, and life expectancy of individuals following spinal cord injury (SCI). This review (1) describes UE use for transfers among individuals with SCI; (2) describes contributing factors associated with UE joint degeneration and loss of transfer independence; (3) summarizes and identi®es gaps in existing research; and (4) provides suggestions for future research. Results: Investigations of wheelchair transfer related UE joint and function preservation among individuals with SCI should consider factors including age and length of time from SCI onset, interface between subject-wheelchair, pain, shoulder joint range of motion (ROM) and muscle strength de®ciencies or imbalances, exercise capacity and tolerance for the physical strain of activities of daily living (ADL), body mass and composition, previous UE injury or disease history, and transfer techniques. Existing studies of transfers among individuals with SCI have relied on small groups of either asymptomatic or non-impaired subjects, with minimal integration of kinematic, kinetic and electromyographic data. Descriptions of UE joint ROM, forces, and moments produced during transfers are lacking. Conclusions: Biomechanical measurement and computer modeling have provided increasingly accurate tools for acquiring the data needed to guide intervention planning to prevent UE joint degeneration and preserve function among individuals with SCI. The identi®cation of stressful sub-components during transfers will enable intervening clinicians and engineers who design and modify assistive and adaptive devices to better serve individuals with SCI. Spinal Cord (2000) 38, 649 ± 657

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Lower Extremity Manifestations of Spasticity in Chronic Spinal Cord Injury

Cited by 126 publications

References 0 publications

Perception of lower limb spasticity in patients with spinal cord injury

Perception of lower limb spasticity in patients with spinal cord injury

Reflex reciprocal facilitation of antagonist muscles in spinal cord injury

Preserving transfer independence among individuals with spinal cord injury

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