Prevalence and Effect of Problematic Spasticity After Traumatic Spinal Cord Injury

Holtz, Kaila A.; Lipson, Rachel; Noonan, Vanessa K.; Kwon, Brian K.; Mills, Patricia

doi:10.1016/j.apmr.2016.09.124

Cited by 123 publications

(111 citation statements)

References 22 publications

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“…This is consistent with previous findings showing that a large proportion of humans with complete SCI develop spasticity. 2-5 This is also consistent with evidence showing that the MAS is sensitive for assessing limb spasticity after chronic complete SCI. 29 Limitations have been highlighted in the inter-rater reliability 30 and validity 31 of the MAS.…”

Section: Discussionsupporting

confidence: 85%

“…2-5 Animal models of SCI showed that, after the injury, spinal motoneurons become highly excitable and sensitive to descending neurotransmitters. 6,7 Animals with spinal cord transection showed more spasticity when residual spinal brainstem-derived monoamines were present.…”

mentioning

confidence: 99%

“…S pasticity, commonly defined as a velocity-dependent increase in muscle tone due to the exaggeration of stretch reflexes, 1 manifests in >60% of people with spinal cord injury (SCI). [2][3][4][5] Animal models of SCI showed that, after the injury, spinal motoneurons become highly excitable and sensitive to descending neurotransmitters. 6,7 Animals with spinal cord transection showed more spasticity when residual spinal brainstem-derived monoamines were present.…”

mentioning

confidence: 99%

“…Self-reported questionnaires indicate that people with incomplete SCI have a higher prevalence of spasticity compared to people with complete SCI. [2][3][4][5] However, the same studies also report higher spasticity in complete compared with incomplete SCI participants depending on the severity of the injury and symptoms tested. Clinical spasticity examinations revealed either similarities or discrepancies in the ability to elicit spasticity in people with complete and incomplete SCI depending on the severity of the injury and symptoms tested.…”

mentioning

confidence: 99%

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Residual descending motor pathways influence spasticity after spinal cord injury

Sangari

Lundell

Kirshblum

et al. 2019

Annals of Neurology

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Objective: Spasticity is one of the most common symptoms manifested in humans with spinal cord injury (SCI). The neural mechanisms contributing to its development are not yet understood. Using neurophysiological and imaging techniques, we examined the influence of residual descending motor pathways on spasticity in humans with SCI. Methods: We measured spasticity in 33 individuals with motor complete SCI (determined by clinical examination) without preservation of voluntary motor output in the quadriceps femoris muscle. To examine residual descending motor pathways, we used magnetic and electrical stimulation over the leg motor cortex to elicit motor evoked potentials (MEPs) in the quadriceps femoris muscle and structural magnetic resonance imaging to measure spinal cord atrophy. Results: We found that 60% of participants showed symptoms of spasticity, whereas the other 40% showed no spasticity, demonstrating the presence of 2 clear subgroups of humans with motor complete SCI. MEPs were only present in individuals who had spasticity, and MEP size correlated with the severity of spasticity. Spinal cord atrophy was greater in nonspastic compared with spastic subjects. Notably, the degree of spared tissue in the lateral regions of the spinal cord was positively correlated with the severity of spasticity, indicating preservation of white matter related to motor tracts when spasticity was present. Interpretation: These results support the hypothesis that preservation of descending motor pathways influences spasticity in humans with motor complete SCI; this knowledge might help the rehabilitation and assessment of people with SCI.

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Section: Discussionsupporting

confidence: 85%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Residual descending motor pathways influence spasticity after spinal cord injury

Sangari

Lundell

Kirshblum

et al. 2019

Annals of Neurology

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“…Spinal hyperexcitability is highly prevalent following spinal cord injury (SCI) and is problematic in at least one-third of patients (Holtz et al 2017). Spasticity is a form of involuntary contraction of muscles following sensory input induced by muscle stretch and it has been characterized as a velocity-dependent phenomenon (Lance, 1990) as a result of the primary endings (1a) that are highly sensitive to the velocity of stretch (Brown & Matthews, 1966).…”

Section: Introductionmentioning

confidence: 99%

Repeated anodal trans‐spinal direct current stimulation results in long‐term reduction of spasticity in mice with spinal cord injury

Mekhael

Begum

Samaddar

et al. 2019

The Journal of Physiology

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Key points Spasticity is a disorder of muscle tone that is associated with lesions of the motor system. This condition involves an overactive spinal reflex loop that resists the passive lengthening of muscles. Previously, we established that application of anodal trans‐spinal direct current stimulation (a‐tsDCS) for short periods of time to anaesthetized mice sustaining a spinal cord injury leads to an instantaneous reduction of spasticity. However, the long‐term effects of repeated a‐tsDCS and its mechanism of action remained unknown. In the present study, a‐tsDCS was performed for 7 days and this was found to cause long‐term reduction in spasticity, increased rate‐dependent depression in spinal reflexes, and improved ground and skill locomotion. Pharmacological, molecular and cellular evidence further suggest that a novel mechanism involving Na‐K‐Cl cotransporter isoform 1 mediates the observed long‐term effects of repeated a‐tsDCS. Abstract Spasticity can cause pain, fatigue and sleep disturbances; restrict daily activities such as walking, sitting and bathing; and complicate rehabilitation efforts. Thus, spasticity negatively influences an individual's quality of life and novel therapeutic interventions are needed. We previously demonstrated in anaesthetized mice that a short period of trans‐spinal subthreshold direct current stimulation (tsDCS) reduces spasticity. In the present study, the long‐term effects of repeated tsDCS to attenuate abnormal muscle tone in awake female mice with spinal cord injuries were investigated. A motorized system was used to test velocity‐dependent ankle resistance and associated electromyographical activity. Analysis of ground and skill locomotion was also performed, with electrophysiological, molecular and cellular studies being conducted to reveal a potential underlying mechanism of action. A 4 week reduction in spasticity was associated with an increase in rate‐dependent depression of spinal reflexes, and ground and skill locomotion were improved following 7 days of anodal‐tsDCS (a‐tsDCS). Secondary molecular, cellular and pharmacological experiments further demonstrated that the expression of K‐Cl co‐transporter isoform 2 (KCC2) was not changed in animals with spasticity. However, Na‐K‐Cl cotransporter isoform 1 (NKCC1) was significantly up‐regulated in mice that exhibited spasticity. When mice were treated with a‐tsDCS, down regulation of NKCC1 was detected, and this level did not significantly differ from that in the non‐injured control mice. Thus, long lasting reduction of spasticity by a‐tsDCS via downregulation of NKCC1 may constitute a novel therapy for spasticity following spinal cord injury.

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Practice Patterns of Physicians Using Adjunct Therapies with Botulinum Toxin Injection for Spasticity: A Canadian Multicenter Cross‐Sectional Survey

Phadke

Boulias

et al. 2020

PM&R

Self Cite

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Background: Adjunct therapies are nonpharmacological treatments used with botulinum toxin (BoNT) injection that may improve spasticity outcomes. It has been suggested that physicians consider adjunct therapies as a part of comprehensive spasticity management. It is unclear which adjunct therapies are used by physicians in clinical practice. Objective: To determine physician practice patterns and perceptions of use of adjunct therapies following BoNT injection for limb spasticity. Design: Cross-sectional national survey of current clinical practice using a 22-item questionnaire developed by the authors. Setting: Not applicable. Participants: Survey respondents were physicians actively administering BoNT injections for limb spasticity management across Canada (N = 48). Interventions: Not applicable. Main Outcome Measures: Types of adjunct therapies used by physicians; physician opinions on barriers to adjunct therapy use, patient preferences, and future research priorities. Results: Most physicians prescribe home stretching programs, home active exercise programs, and splinting; however, many physicians perceive that these same adjunct therapies are unwanted by patients. A minority of physicians prescribe electrical stimulation (ES), transcutaneous electrical nerve stimulation (TENS), casting, and extracorporeal shockwave therapy; financial limitations and perceived lack of evidence were identified as barriers to their use. Significantly more physicians practicing in academic settings compared with nonacademic, community, and private practice settings used functional ES (59% vs 11%) and TENS (41% vs 0%) as adjunct therapies (P < .05). Research priorities included determining the effectiveness of immediate postinjection application of adjunct therapies (eg, injected muscle activation with ES or stretching) and nutraceuticals. Conclusions: Canadian physicians frequently use adjunct therapies in combination with BoNT injection to treat spasticity. Financial and time constraints are identified as barriers to implementation of adjunct therapies that are currently supported by research, and patient preferences may also affect compliance. Future research should focus on adjunct therapies that overcome these barriers.

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Prevalence and Effect of Problematic Spasticity After Traumatic Spinal Cord Injury

Cited by 123 publications

References 22 publications

Residual descending motor pathways influence spasticity after spinal cord injury

Residual descending motor pathways influence spasticity after spinal cord injury

Repeated anodal trans‐spinal direct current stimulation results in long‐term reduction of spasticity in mice with spinal cord injury

Practice Patterns of Physicians Using Adjunct Therapies with Botulinum Toxin Injection for Spasticity: A Canadian Multicenter Cross‐Sectional Survey

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