Spasticity

Spasticity is typically experienced by individuals with spinal cord injury (SCI) following a period of spinal shock, and, in most cases, these symptoms negatively impact quality of life [1-4].

There is great variability in definitions of spasticity, but the most commonly cited definition states: ‘Spasticity is a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex, as one component of the upper motor neuron syndrome’ [5].

The prevalence of spasticity after SCI has been shown to be 65-78% of persons who are greater than 1-year post-injury [6, 7], and has been shown to restrict activities of daily living and cause pain [2, 7].  Further, the symptoms of spasticity may have a profound influence on an individual’s lifestyle and sense of well-being [8] by limiting workplace participation and adding to the cost of medication and attendant care [6, 9, 10].  In understanding the impact of spasticity, qualitative findings [11] suggest that spasticity can be understood in seven domains: physical, activity, emotional, economic, interpersonal, management, and cognitive.  Interestingly, some persons’ viewed their spasticity as being beneficial, and their understanding of the condition was not necessarily consistent with clinical definitions.  As well, some persons with SCI view their spasticity as being beneficial for functioning [11].

Regardless, spasticity remains a common secondary health condition that has the potential to negatively affect several domains of well-being and functioning after SCI.

References

1. Adams MM, Hicks AL. Spasticity after spinal cord injury. Spinal Cord 2005;43:577-86.

2. Sköld C, Levi R, Seiger A. Spasticity after traumatic spinal cord injury: nature, severity, and location. Arch Phys Med Rehabil 1999;80:1548-57.

3. Kirshblum S. Treatment alternatives for spinal cord injury related spasticity. J Spinal Cord Med 1999;22:199-217.

4. Sheean G. The pathophysiology of spasticity. Eur J Neurol 2002;9 (Suppl):3-9.

5. Lance JW. Symposium synopsis. In: Young RR, Koeila WE, editors. Spasticity: disordered motor control. Chicago: Yearbook Medical Publishers; 1980. p 485-94.

6. Maynard FM, Karunas RS, Waring WP. Epidemiology of spasticity following traumatic spinal cord injury. Arch Phys Med Rehabil 1990;71:566-9.

7. Levi R, Hultling C, Seiger A. The Stockholm Spinal Cord Injury Study: 2. Associations between clinical patient characteristics and post-acute medical problems. Paraplegia 1995;33:585-94.

8. Gianino JM, York MM, Paice JA, Shott S. Quality of life: Effect of reduced spasticity from intrathecal baclofen. J Neurosci Nurs 1998;30:47-54.

9. Canadian Paraplegic Association. Workplace participation national survey of Canadians with SCI. 1996.

10. Walter JS, Sacks J, Othman R, Rankin AZ, Nemchausky B, Chintam R et al. A database of self-reported secondary medical problems among VA spinal cord injury patients: its role in clinical care and management. J Rehabil Res Dev 2002;79:53-61.

11. Mahoney JS, Engebretson JC, Cook KF, Hart KA, Robinson-Whelen S, Sherwood AM. Spasticity experience domains in persons with spinal cord injury. Arch Phys Med Rehabil 2007; 88: 287-294.