Spasticity In Spinal Cord Injury Research Articles

Effects of the Exopulse Mollii suit on spasticity and gait in spinal cord injury

Effects of the Exopulse Mollii suit on spasticity and gait in spinal cord injury

Lumbar epidural steroid injection for spasticity in paraplegic spinal cord injury: A case report

This is the case of a 33-year-old male with traumatic paraplegic lumbar spinal cord injury after knife assault, who was unable to participate in an intensive inpatient rehabilitation course due to bilateral lower limb spasticity. For therapeutic management of spasticity at the bedside in the inpatient rehabilitation setting, we performed an epidural steroid injection to the right L4-L5 interspace. After the intervention, a significant decrease in spasticity was noted. The patient could subsequently tolerate sit-to-stand transfers with a standing frame and ambulate with the an exoskeleton device in inpatient physical therapy, significantly improving his overall functional level in therapies. This case demonstrates that bedside epidural steroid injection can dramatically improve paraplegic spasticity secondary to lumbar spinal cord injury in the inpatient rehabilitation setting.

Neurophysiological and clinical outcome measures of the impact of electrical stimulation on spasticity in spinal cord injury: Systematic review and meta-analysis.

This systematic review and meta-analysis aims to determine whether non-invasive electrical stimulation (ES) is effective at reducing spasticity in people living with spinal cord injury (SCI). PubMed, Web of Science, Scopus and Cochrane Central Register of Controlled Trials databases were searched in April 2022. Primary outcome measures were the Ashworth scale (AS), Modified Ashworth scale (MAS), Pendulum test and the Penn spasm frequency scale (PSFS). Secondary outcomes were the Hoffman (H)- reflex, motor-evoked potentials (MEPs) and posterior-root reflexes (PRRs). A random-effects model, using two correlation coefficients, ( , ) determined the difference between baseline and post-intervention measures for RCTs. A quantitative synthesis amalgamated data from studies with no control group (non-RCTs). Twenty-nine studies were included: five in the meta-analysis and 17 in the amalgamation of non-RCT studies. Twenty studies measured MAS or AS scores, 14 used the Pendulum test and one used the PSFS. Four measured the H-reflex and no studies used MEPs or PRRs. Types of ES used were: transcutaneous electrical nerve stimulation (TENS), transcutaneous spinal cord stimulation (TSCS), functional electrical stimulation (FES) cycling and FES gait. Meta-analyses of 3 studies using the MAS and 2 using the Pendulum test were carried out. For MAS scores, non-invasive ES was effective at reducing spasticity compared to a control group (p = 0.01, ; p = 0.002, ). For Pendulum test outcomes, there was no statistically significant difference between intervention and control groups. Quantitative synthesis of non-RCT studies revealed that 22 of the 29 studies reported improvement in at least one measure of spasticity following non-invasive ES, 13 of which were statistically significant (p < 0.05). Activation of the muscle was not necessary to reduce spasticity. Non-invasive ES can reduce spasticity in people with SCI, according to MAS scores, for both RCT and non-RCT studies, and Pendulum test values in non-RCT studies. This review could not correlate between clinical and neurophysiological outcomes; we recommend the additional use of neurophysiological outcomes for future studies. The use of TSCS and TENS, which did not induce a muscle contraction, indicate that activation of afferent fibres is at least required for non-invasive ES to reduce spasticity.

Safety and Potential Efficacy of Selective Dorsal Rhizotomy in Adults with Spinal Cord Injury-Induced Spasticity: An Open-Label, Non-Randomized, Single-Arm Trial

Despite the abundant literature on the use of selective dorsal rhizotomy (SDR) in spastic cerebral palsy, no investigation has evaluated its use in adult patients with chronic spinal cord injury (SCI)-induced spasticity. The present investigation aimed to evaluate the safety and potential efficacy of SDR in chronic SCI-induced spasticity for the first time. In this open-label, single-arm, non-randomized clinical trial, all patients were assigned to the single study intervention arm and underwent SDR. The primary outcome measure was the safety profile of SDR. Secondary outcome measures were Modified Ashworth Scale, Penn Spasm Frequency Scale, visual analog scale for spasticity, Spinal Cord Injury Spasticity Tool, Spinal Cord Independence measure version III, and Short Form 36 Health Survey Questionnaire. Six patients with cervical SCI and 4 with thoracic SCI were allocated to the single study intervention arm. No adverse event attributable to the SDR was found. Moreover, all secondary outcome measures of the study improved significantly over the study period (P < 0.001). Multiple regression analysis also found a significant association between level of injury and changes in average Modified Ashworth Scale scores (P= 0.041), Spinal Cord Injury Spasticity Tool score (P= 0.013), and Spinal Cord Independence measure version III total (P= 0.002) and mobility domain scores (P= 0.004) at 12-month postoperatively. This clinical trial indicated that SDR is a safe and potentially effective procedure in patients with severe and intractable SCI-induced spasticity. However, future clinical trials with larger sample sizes and adequate power are required to validate our findings regarding efficacy.

Modulation of Motor Cortex Activity After Intrathecal Baclofen Delivery in Chronic Thoracic Spinal Cord Injury.

ObjectivesIntrathecal baclofen (ITB) is commonly used for reduction of spasticity in chronic spinal cord injury (SCI). Its clinical effect is well-known; however, exact mechanisms of long-term effect of continuous ITB administration (cITBa) on modulation of cortical processes have not been elucidated. The aim of this study was to evaluate changes in motor cortex activation for healthy upper limbs in comparison to impaired lower limbs by functional magnetic resonance imaging (fMRI).MethodsTen subjects (eight males, 20–69 years) with thoracic SCI presenting no voluntary movements of lower limbs (except one) were enrolled in the fMRI study. fMRI at 1.5T with a finger tapping paradigm and mental movement simulating foot flexion on the dominant side were performed before, 3 months, and 1 year after start of cITBa. fMRI data processing was carried out using FMRI Expert Analysis Tool (FEAT), part of FSL. A second-level analysis was carried out using FLAME stages 1 and 2. The level of spasticity was assessed with the Modified Ashworth scale (MAS).ResultsContinuous ITB significantly decreased limb spasticity in all the subjects (group MAS spasticity dropped from 3 to 0.3). The second-level analysis (Z > 1.6, cluster significance threshold p =0.05) revealed increased activation of the primary sensorimotor cortex of the foot between baseline and 3 months, and 3 months and 1 year.ConclusionIncreased sensorimotor cortex activation with spasticity reduction after cITBa may reflect distant functional reorganization because of long-term mediated neuroplastic changes in the sensorimotor cortex. Better understanding of modulation of brain function in SCI after cITBa may influence the field of neurorehabilitation.

Intrathecal baclofen therapy in the management of drug-resistant muscle spasticity in patients with traumatic spinal cord injury

Neurorehabilitation of patients with spinal cord injury and severe muscle spasticity have always been one of the most challenging tasks for neurologists. Muscle spasticity significantly impairs patients’ quality of life and is often resistant to pharmacotherapy. Over the last 10 years, intrathecal baclofen therapy has become the most effective treatment for spasticity in Russia. In this study, we tried to systematize the data on intrathecal baclofen therapy in patients with spinal cord injury complicated by spasticity and to evaluate their treatment outcomes, as well as the incidence of adverse events. Our findings will ultimately help to clarify the need for intrathecal baclofen therapy in routine clinical practice.

Evidence of treating spasticity before it develops: a systematic review of spasticity outcomes in acute spinal cord injury interventional trials.

Introduction: Spasticity is a common consequence of spinal cord injury (SCI), estimated to affect up to 93% of people living with SCI in the community. Problematic spasticity affects around 35% people with SCI spasticity. The early period after injury is believed to be the most opportune time for neural plasticity after SCI. We hypothesize that clinical interventions in the early period could reduce the incidence of spasticity. To address this, we evaluated the spasticity outcomes of clinical trials with interventions early after SCI.Methods: We performed a systematic review of the literature between January 2000 and May 2021 to identify control trials, in humans and animals, that were performed early after SCI that included measures of spasticity in accordance with PRISMA guidelines.Results: Our search yielded 1,463 records of which we reviewed 852 abstracts and included 8 human trial peer-reviewed publications and 9 animal studies. The 9 animal trials largely supported the hypothesis that early intervention can reduce spasticity, including evidence from electrophysiological, behavioral, and histologic measures. Of the 8 human trials, only one study measured spasticity as a primary outcome with a sample size sufficient to test the hypothesis. In this study, neuromodulation of the spinal cord using electric stimulation of the common peroneal nerve reduced spasticity in the lower extremities compared to controls.Conclusion: Given the prevalence of problematic spasticity, there is surprisingly little research being performed in the early period of SCI that includes spasticity measures, and even fewer studies that directly address spasticity. More research on the potential for early interventions to mitigate spasticity is needed.

Improvement of Memory Functions in Chronic Spinal Cord Injury After Long-Term Intrathecal Baclofen Delivery for Spasticity Relief

Intrathecal baclofen (ITB) pump delivery systems are safe and effective in the treatment of generalized spasticity in chronic spinal cord injury (SCI). Despite its widespread use, few and discrepant data are available in animal studies on the effects of ITB on cognitive functions, such as memory. The effects of chronic administration of baclofen on humans have not been investigated to date. The aim of this study is to find out, whether a long-term administration of ITB has any effects on cognitive functions in SCI subjects. In 11 out of 22 subjects with chronic SCI, we performed comprehensive neuropsychological assessment carried out using specialized tests focused on memory and other higher cognitive domains and emotional state. All patients receiving ITB treatment for spasticity relief improved significantly in RAVLT Trials 1-5 (p=0.049), Logical memory-immediate recall (p=0.019) and Logical memory-delayed recall (p=0.008). Visual memory, long-term semantic memory, attention, executive, perceptual and spatial functions, and mood status remained stable. No significant decline in memory functions were detected following one year of ITB delivery, creating an opportunity for careful prescription of this treatment in chronic SCI. Moreover, we have detected a significant increase in short-term auditory-verbal memory and logical memory performance.

Characterizing the Experience of Spasticity after Spinal Cord Injury: A National Survey Project of the Spinal Cord Injury Model Systems Centers

ObjectiveTo characterize the qualities that individuals with spinal cord injury (SCI) associate with their experience of spasticity and to describe the relationship between spasticity and perceived quality of life and the perceived value of spasticity management approaches. DesignOnline cross-sectional survey. SettingMulticenter collaboration among 6 Spinal Cord Injury Model Systems hospitals in the United States. ParticipantsIndividuals with SCI (N=1076). InterventionsNot applicable. Main Outcome MeasuresQualities of Spasticity Questionnaire, modified Spinal Cord Injury–Spasticity Evaluation Tool (mSCI-SET), and the modified Patient-Reported Impact of Spasticity Measure (mPRISM). ResultsRespondents indicated that spasms most often occurred in response to movement-related triggering events. However, spontaneous spasms (ie, no triggering event) were also reported to be among the most common types. Frequency of spasms appears to decline with age. The highest frequency of spasms was reported by 56% of respondents aged <25 years and by only 28% of those >55 years. Stiffness associated with spasticity was reported to be more common than spasms (legs, 65% vs 54%; trunk, 33% vs 18%; arms, 26% vs 15%). Respondents reported negative effects of spasticity more commonly than positive effects. Based on their association with negative scores on the mSCI-SET and the mPRISM, the 5 most problematic experiences reported were stiffness all day, interference with sleep, painful spasms, perceived link between spasticity and pain, and intensification of pain before a spasm. Respondents indicated spasticity was improved more by stretching (48%) and exercise (45%) than by antispasmodics (38%). ConclusionsThe experience of spasticity after SCI is complex and multidimensional, with consequences that affect mobility, sleep, comfort, and quality of life. Stiffness, rather than spasms, appears to be the most problematic characteristic of spasticity. Physical therapeutic interventions to treat spasticity warrant in-depth investigation.

Botulinum Toxin: From Poison to Possible Treatment for Spasticity in Spinal Cord Injury.

Botulism has been known for about three centuries, and since its discovery, botulinum toxin has been considered one of the most powerful toxins. However, throughout the 20th century, several medical applications have been discovered, among which the treatment of spasticity stands out. Botulinum toxin is the only pharmacological treatment recommended for spasticity of strokes and cerebral palsy. Although its use as an adjuvant treatment against spasticity in spinal cord injuries is not even approved, botulinum toxin is being used against such injuries. This article describes the advances that have been made throughout history leading to the therapeutic use of botulinum toxin and, in particular, its application to the treatment of spasticity in spinal cord injury.

Combined Transcutaneous Spinal Stimulation and Locomotor Training to Improve Walking Function and Reduce Spasticity in Subacute Spinal Cord Injury: A Randomized Study of Clinical Feasibility and Efficacy.

Locomotor training (LT) is intended to improve walking function and can also reduce spasticity in motor-incomplete spinal cord injury (MISCI). Transcutaneous spinal stimulation (TSS) also influences these outcomes. We assessed feasibility and preliminary efficacy of combined LT + TSS during inpatient rehabilitation in a randomized, sham-controlled, pragmatic study. Eighteen individuals with subacute MISCI (2–6 months post-SCI) were enrolled and randomly assigned to the LT + TSS or the LT + TSSsham intervention group. Participants completed a 4-week program consisting of a 2-week wash-in period (LT only) then a 2-week intervention period (LT + TSS or LT + TSSsham). Before and after each 2-week period, walking (10 m walk test, 2-min walk test, step length asymmetry) and spasticity (pendulum test, clonus drop test, modified spinal cord injury—spasticity evaluation tool) were assessed. Sixteen participants completed the study. Both groups improved in walking speed and distance. While there were no significant between-groups differences, the LT + TSS group had significant improvements in walking outcomes following the intervention period; conversely, improvements in the LT + TSSsham group were not significant. Neither group had significant changes in spasticity, and the large amount of variability in spasticity may have obscured ability to observe change in these measures. TSS is a feasible adjunct to LT in the subacute stage of SCI and may have potential to augment training-related improvements in walking outcomes.

Role of Baclofen in Modulating Spasticity and Neuroprotection in Spinal Cord Injury

Spinal cord injury (SCI) affects an estimated three million persons worldwide, with ∼180,000 new cases reported each year leading to severe motor and sensory functional impairments that affect personal and social behaviors. To date, no effective treatment has been made available to promote neurological recovery after SCI. Deficits in motor function is the most visible consequence of SCI; however, other secondary complications produce a significant impact on the welfare of patients with SCI. Spasticity is a neurological impairment that affects the control of muscle tone as a consequence of an insult, trauma, or injury to the central nervous system, such as SCI. The management of spasticity can be achieved through the combination of both nonpharmacological and pharmacological approaches. Baclofen is the most effective drug for spasticity treatment, and it can be administered both orally and intrathecally, depending on spasticity location and severity. Interestingly, recent data are revealing that baclofen can also play a role in neuroprotection after SCI. This new function of baclofen in the SCI scope is promising for the prospect of developing new pharmacological strategies to promote functional recovery in patients with SCI.

Physiotherapy interventions for the treatment of spasticity in people with spinal cord injury: a systematic review.

Systematic review. To determine the effectiveness of physiotherapy interventions for the treatment of spasticity in people with spinal cord injuries. Not applicable. A comprehensive search was undertaken to identify all randomised controlled trials of physiotherapy interventions that included an assessor-reported (objective) or participant-reported (subjective) measure of spasticity. Only trials that provided a physiotherapy intervention on more than one occasion were included. The susceptibility to bias of each trial was rated on the PEDro scale. Data were extracted to derive mean between-group differences (95% CI) for each trial. Twenty-eight trials were identified but only 17 provided useable data. Seven trials compared a physiotherapy intervention to no intervention (or a sham intervention) and 10 trials compared one physiotherapy intervention to another physiotherapy intervention. The median (IQR) PEDro score of the 17 trials was 6/10 (6-8). The most commonly used assessor- and participant-reported measures of spasticity were the Ashworth scale and Spinal Cord Injury Spasticity Evaluation Tool, respectively. Only one trial demonstrated a treatment effect. This trial compared continuous passive motion of the ankle to no treatment on the Ashworth scale. The remaining 16 trials were either inconclusive or indicated that the treatment was ineffective for reducing spasticity. There is no high-quality evidence to indicate that physiotherapy interventions decrease spasticity but this may reflect a lack of research on the topic. Future trials should focus on participant-reported measures of spasticity that distinguish between the immediate, short-term and long-term effects of any physiotherapy intervention.

The Effect of High Frequency Repetitive Transcranial Magnetic Stimulation on Community Ambulation Ability in Spinal Cord Injury Patients: A Randomized Controlled Trial

This study was conducted to investigate the effects of high frequency repetitive transcranial magnetic stimulation (rTMS) on spasticity and gait ability in incomplete spinal cord injury (SCI) patients. 14 subjects were randomly assigned to each of 7 experimental and control groups. 20 Hz high frequency rTMS was applied to the experimental group for 20 minutes per day, 5 times a week for a total of 4 weeks and sham rTMS was applied to the control group. The subjects were assessed for spasticity by Modified Ashworth Scale (MAS) and Spinal Cord Injury Assessment Tool for Spasticity (SCATS). In the evaluation of gait ability, 10 Meter Walk Test (10MWT) for gait speed and Community walk test (CWT) for ability of community ambulation were used. A significant improvement in MAS, SCATS, 10MWT and CWT was observed after intervention in the experimental group (p 0.05), and there was a significant improvement in all evaluation items compared to the control group (p 0.05). The results of this study suggest that high frequency rTMS applied to primary motor cortex (M1) positively affects spasticity and gait ability in incomplete spinal cord injury patients.

Intrathecal baclofen pump replacements under local anaesthetic: rapid pathway implementation under COVID-19

Intrathecal baclofen pump replacements under local anaesthetic: rapid pathway implementation under COVID-19

Modified PRISM and SCI-SET Spasticity Measures for Persons With Traumatic Spinal Cord Injury: Results of a Rasch Analyses

ObjectiveTo evaluate the psychometric properties of the Spinal Cord Injury Spasticity Evaluation Tool (SCI-SET) and Patient-Reported Impact of Spasticity Measure (PRISM) using Rasch analysis to optimize their validity and efficiency. DesignRasch analysis of the SCI-SET and PRISM represents a secondary analysis of data collected as part of a collaborative research project of the SCI Model Systems Centers. The overall survey was organized into 4 sections: (1) participant demographics and injury characteristics, (2) participant experiences of spasticity, (3) SCI-SET, and (4) PRISM. Participants were recruited from the community via multiple avenues. Data were collected and managed via an online survey tool using a secure web-based data management application. SettingParticipating Spinal Cord Injury Model Systems Centers. ParticipantsMost participants (N=1239) had lived with their injury for more than 2 years and used a wheelchair as their primary mode of mobility. The majority of the sample (58%) sustained cervical injuries. InterventionsNone. Main Outcome MeasuresSCI-SET and PRISM. ResultsThe SCI-SET demonstrated strong measurement properties with acceptably high reliability and point-measure correlations and no evidence of multidimensionality. However, respondents underused some rating scale categories. Analyses of the PRISM demonstrated 3 distinct subscales relating to the physical, psychological, and social influences of spasticity; respondents underused some rating scale categories. Combining underused rating scale categories for both spasticity instruments resulted in increased reliability and reduced respondent burden compared with the original versions. Both the Modified SCI-SET (person separation reliability=0.93) and Modified PRISM (person separation reliability=0.85, 0.89, 0.83 for physical, psychological, and social subscores, respectively) display strong measurement properties. ConclusionsMeasurement properties of the SCI-SET and PRISM improved from use of Rasch model methods. The SCI-SET required minor revisions, whereas the PRISM required definition of subscores. Both modified spasticity measures demonstrated adequate psychometric properties, and correlations among the modified measures were high, providing evidence of convergent validity. We recommend use of the Modified SCI-SET and Modified PRISM measures in future studies.

Comparison of Spasticity in Spinal Cord Injury and Stroke Patients Using Reflex Period in Pendulum Test.

Spasticity is a motor impairment present in patients with both stroke and spinal cord injury. In this research, the results from the Wartenberg pendulum test, performed on stroke and spinal cord injury patients using goniometers and electromyogram recordings of the quadriceps, were reviewed and a new parameter to quantify spasticity was extracted. The Reflex Period (RP) of the pendulum test was defined as the time span from 50% of the maximum velocity of the leg swing to the activation of muscle contraction in the quadriceps, determined from the EMG. The results suggest that the reflex period in stroke patients is generally shorter than in those suffering from spinal cord injury.

Pulsed Magnetic Stimulation - Managing Spasticity in Spinal Cord Injury

Pulsed Magnetic Stimulation - Managing Spasticity in Spinal Cord Injury

Aplicaciones terapéuticas por acción de los cannabinoides.

The interest on cannabinoids became evident between the 1940 and 1950 decades. Although the active substance of the plant was not known, a series of compounds with cannabinomimetic activity were synthesized, which were investigated in animals and clinically. The most widely tested was Δ6a, 10a-THC hexyl. Δ6a, 10a-THC dimethylheptyl (DMHP) antiepileptic effects were studied in several children, with positive results being obtained in some cases. DMHP differs from sinhexyl in that its side chain is DMHP instead of n-hexyl. The first cannabinoid isolated from Cannabis sativa was cannabinol, although its structure was correctly characterized several years later. Cannabidiol was isolated some years later and was subsequently characterized by Mechoulam and Shvo. In 2013, the National Academy of Medicine and the Faculty of Medicine of the National Autonomous University of Mexico, through the Seminar of Studies on Entirety, decided to carry out a systematic review on a subject that is both complex and controversial: the relationship between marijuana and health. In recent years, studies have been conducted with cannabis in several diseases: controlled clinical trials on spasticity in multiple sclerosis and spinal cord injury, chronic, essentially neuropathic, pain, movement disorders (Gilles de Latourette, dystonia, levodopa dyskinesia), asthma and glaucoma, as well as non-controlled clinical trials on Alzheimer's disease, neuroprotection, intractable hiccups, epilepsy, alcohol and opioid dependence and inflammatory processes.

Effect of electrical stimulation on muscle atrophy and spasticity in patients with spinal cord injury - a systematic review with meta-analysis.

This work is a systematic review with meta-analysis OBJECTIVE: Evaluate the effect of electrical stimulation (ES) on skeletal muscle volume and spasticity in individuals with spinal cord injury (SCI). University of Brasilia, Brazil METHODS: Searches were conducted of the Cochrane Library, MEDLINE, CINAHL, PEDro, PsycINFO and EMBASE electronic databases for relevant articles published up to June 2018. No restrictions were imposed regarding the year of publication. The inclusion criteria were randomized controlled trials involving adults with SCI comparing ES to an active or passive control. Two independent reviewers extracted the data from the selected studies and methodological quality was assessed using the PEDro scale. The initial search led to the retrieval of 164 studies, seven of which met the eligibility criteria, but only six were included in the meta-analysis. The six studies comprised 104 patients with complete or incomplete SCI. In the two studies that investigated the use of ES on muscle volume of the lower limbs, the overall effect was statistically significant in patients with acute SCI (mean difference: 0.86; 95% CI: 0.04 to 1.69; p < 0.04). Among the four studies that examined the use of ES for spasticity of the lower limb, the overall effect was non-significant (mean difference: 0.55; 95% CI: -0.31 to 1.41; p = 0.21). Electrical stimulation was found to be an effective method for increasing muscle volume in SCI patients, but had no effect on spasticity. Further investigation of the effect of ES on spasticity in SCI is needed.