Spasticity in spinal cord injury: Self- and clinically rated intrinsic fluctuations and intervention-induced changes

Sköld, Camilla

doi:10.1016/s0003-9993(00)90132-1

Cited by 80 publications

(76 citation statements)

References 19 publications

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“…The VAS is a valid and reliable measure in rating pain intensity and is presently being used more often for the assessment of spasticity. 11,13 The level of spasticityrelated discomfort was scored using the Borg scale. The Borg scale is a widely used scale for perceived exertion in exercise, 15,16 but is new in this field.…”

Section: Questionnairementioning

confidence: 99%

“…The patients' evaluation of spasticity is often an ad hoc report and is rarely documented by using measurement tools like the spasm frequency scale or a visual analog scale (VAS). [11][12][13] Usually no differentiation is made between the perceived degree of spasticity and the experienced spasticity-related level of discomfort. Figure 1 shows a proposed basic model, showing the interrelationship between the different components of the ICF framework and the perception of the patient.…”

Section: Introductionmentioning

confidence: 99%

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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: Questionnairementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Perception of lower limb spasticity in patients with spinal cord injury

et al. 2008

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“…7 Although MAS is the most commonly used tool for measuring spasticity in clinical practice and research, the reliability and validity of this scale remain unclear. 27,28 Moreover, the degree of spasticity can vary according to the patient's physical and emotional conditions, even within a single day. 28 Therefore, to separate the two groups (no or mild spasticity group vs severe spasticity group) clearly, we excluded six subjects with moderate spasticity from the analysis.…”

Section: Discussionmentioning

confidence: 99%

“…27,28 Moreover, the degree of spasticity can vary according to the patient's physical and emotional conditions, even within a single day. 28 Therefore, to separate the two groups (no or mild spasticity group vs severe spasticity group) clearly, we excluded six subjects with moderate spasticity from the analysis. In addition, to ensure an accurate assessment of the differences between the groups, we evaluated the SCATS and the PSFS scores, as well as the MAS scores.…”

Section: Discussionmentioning

confidence: 99%

Severe spasticity in lower extremities is associated with reduced adiposity and lower fasting plasma glucose level in persons with spinal cord injury

et al. 2016

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Study design: Cross-sectional study. Objectives: To investigate the effects of severe lower extremity spasticity on anthropometric dimensions, body composition and metabolic profiles in persons with chronic motor complete spinal cord injury (SCI). Setting: Outpatient clinic. Methods: Fifty-five of the 61 participants were divided into two groups (no or mild spasticity group, 28; severe spasticity group, 27) based on the assessment of the extensor muscle spasticity according to the modified Ashworth scale. Anthropometric dimensions (waist circumference (WC), waist-to-height ratio (WtHR)), body composition (fat mass (FM), body fat percentage (BFP), fat-free mass (FFM), fat-free mass percentage (FFMP), bone mineral density (BMD)) and metabolic profiles (leptin, total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride (TG), fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c)) were compared between the two groups with different degree of spasticity. Results: Spasticity of the extensor muscle group negatively correlated with BFP (r = − 0.458, Po0.001). Patients with severe spasticity showed a lower WC and WtHR than those in the no or mild spasticity group (P = 0.038, P = 0.006, respectively). The FM, BFP, leptin and FPG of the severe spasticity group were significantly lower than those of the patients in the no or mild spasticity group (P = 0.003, Po0.001, Po0.001 and P = 0.037, respectively). However, no differences in BMD, total cholesterol, LDL, HDL, TG and HbA1c were observed between the groups. Conclusions: The results of this study suggest that severe spasticity in lower extremities is associated with reduced adiposity and lower FPG levels in persons with chronic motor complete SCI.

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“…6 Spasticity was evaluated by the same investigator while the patient was in a supine position using standard procedures. 13 Room temperature was maintained constant between 21 and 24 1C. Three scores were reported for each specific muscle group and were then averaged (Table 1).…”

Section: First Visitmentioning

confidence: 99%

Oral baclofen administration in persons with chronic spinal cord injury does not prevent the protective effects of spasticity on body composition and glucose homeostasis

2009

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Study design: Correlation study. Objectives: To determine the effects of oral baclofen on body composition (fat mass (FM), fat-free mass (FFM)), extra-and intracellular fluid compartments and glucose homeostasis (plasma glucose and plasma insulin concentrations) in individuals with spinal cord injury (SCI) after controlling for spasticity. Settings: Laboratory settings at the University of Michigan, MI, USA. Methods: Fifteen individuals with chronic motor complete SCI (32 ± 8 years old, 25 ± 5 kg/m 2 , C6-T11, American Spinal Injury Association A and B) underwent multifrequency bioelectrical impedance analysis to measure body composition and body fluid compartments. Spasticity of the hip, knee and ankle flexors and extensors was measured using a modified Ashworth Scale and the dose of daily oral baclofen was recorded. After overnight fasting, plasma glucose and insulin sensitivity were measured in response to an oral glucose tolerance test. Results: Oral baclofen dose was positively related to body mass index, but not to extensor or flexor spasticity. The dose of baclofen seemed to be correlated to extensor spasticity after considering spasticity per FFM. The increased dose of oral baclofen was positively associated with increased FFM, extra-and intracellular fluid compartments and total body water, but not with FM. Oral baclofen dose was negatively associated with the homeostatic model assessment index. Conclusion: Administration of oral baclofen did not attenuate the protective effects of spasticity on body composition and metabolic profile after SCI. The possibility that oral baclofen could exert an independent protective effect needs to be further investigated.

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Spasticity in spinal cord injury: Self- and clinically rated intrinsic fluctuations and intervention-induced changes

Cited by 80 publications

References 19 publications

Perception of lower limb spasticity in patients with spinal cord injury

Perception of lower limb spasticity in patients with spinal cord injury

Severe spasticity in lower extremities is associated with reduced adiposity and lower fasting plasma glucose level in persons with spinal cord injury

Oral baclofen administration in persons with chronic spinal cord injury does not prevent the protective effects of spasticity on body composition and glucose homeostasis

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