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

Abstract

Travmatik omurilik yaralanmalı hastalarda spastisite: Hastaların ve hekimlerin perspektifinden ABSTRACT Objectives: This study aims to investigate the incidence and severity of spasticity in patients with traumatic spinal cord injury (TSCI) from the perspective of both patients and physicians. Patients and methods: Between January 2006 and December 2010, a total of 119 TSCI patients (91 males, 28 females; mean age 34.9±13.1 years; range 18 to 79 years) were included in the study. The patients were asked for localization of the spasticity, its beneficial and harmful effects and whether it caused pain. The patients with pain were evaluated using the visual analog scale (VAS). The physicians used the Modified Ashworth Scale (MAS) for all patients. The spasticity was also evaluated using the Penn Spasm Frequency Scale, Spasm Severity Scale, Hygiene Scale, Deep Tendon Reflexes Scale, Clonus Score, and the Plantar Stimulation Response Scale. The patients were functionally evaluated with the Barthel Index (BI) and the Functional Independence Measurement (FIM). Results: Spasticity was reported by 42 patients (35.3%). Based on the MAS evaluation of the physicians, 54 patients (45.4%) had spasticity. The FIM, BI, and VAS scores of patients with spasticity were statistically significantly worse than those without spasticity. There was a statistically significant correlation between the spasticity evaluation performed by the physicians and patients (r=0.772; p=0.001). We also found a significant correlation between the MASS and VAS scores (r=0.200; p=0.029) and between the patient-reported spasticity and VAS scores (r=0.345; p=0.001). Conclusion: Our study results suggest that different measurement tools should be used during clinical examination to accurately evaluate the incidence and severity of spasticity in TSCI patients.

Long-term effect of intrathecal baclofen treatment on bone health and body composition after spinal cord injury: A case matched report

“…Spasticity is a sequela of spinal cord injury (SCI) associated with upper motor neuron disorder[ 1 - 3 ]. Seventy percent or more of individuals with chronic SCI experience spasticity[ 1 - 3 ].…”

“…Spasticity is a sequela of spinal cord injury (SCI) associated with upper motor neuron disorder[ 1 - 3 ]. Seventy percent or more of individuals with chronic SCI experience spasticity[ 1 - 3 ]. Spasticity is more prevalent in individuals with motor complete or incomplete injury of cervicothoracic origin[ 3 - 6 ].…”

“…Seventy percent or more of individuals with chronic SCI experience spasticity[ 1 - 3 ]. Spasticity is more prevalent in individuals with motor complete or incomplete injury of cervicothoracic origin[ 3 - 6 ]. The most commonly cited definition of spasticity was proposed by Lance in 1980[ 3 , 4 ] and it is defined as, “a motor disorder characterized by velocity-dependent increase in the tonic stretch reflexes (muscle tone) with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflexes as one component of the upper motor neuron syndrome”[ 1 - 3 ].…”

“…Spasticity is recognized for its deleterious as well as beneficial effects on health outcomes after SCI[ 5 ]. A mild or moderate spasticity may provide stability for sitting, bed mobility, transfers, standing for assistance with self-care, walking, and grip on assistive devices for self-care or feeding[ 3 , 5 ]. Furthermore, spasticity has been reported to have a positive influence on muscle mass and body composition in persons with SCI[ 6 , 7 ].…”

“…On the contrary, severe spasticity may result in negative consequences on several health variables including functional mobility, quality of life, and it may accentuate lower extremity pain[ 3 , 5 ]. Also, functional limitations from spasticity can increase the risk of contractures, pressure injuries, infections, and falls[ 3 , 5 ] thereby impacting quality of life and may result in social isolation for persons with SCI. A variety of pharmacological and non-pharmacological treatments are available for the control of severe spasticity[ 9 ].…”