Incidence and predictors of contracture after spinal cord injury—a prospective cohort study

Diong, Joanna; Harvey, L A; Kwah, Li Khim; Eyles, J.P.; Ling, Matina; Ben, Marsha; Herbert, Robert D.

doi:10.1038/sc.2012.25

Cited by 81 publications

(50 citation statements)

References 23 publications

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“…Spasticity can have influence on body functions and structures, 15 activities and participation. Our study focused on the influence of spasticity on activities.…”

Section: Discussionmentioning

confidence: 99%

Functional hindrance due to spasticity in individuals with spinal cord injury during inpatient rehabilitation and 1 year thereafter

et al. 2015

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Study design: Prospective cohort study. Objective: To assess functional hindrance due to spasticity during inpatient rehabilitation and 1 year thereafter in individuals with spinal cord injury (SCI) and to determine factors that influence the hindrance. Setting: Eight specialized rehabilitation centres in the Netherlands. Methods: A total of 203 patients with recent SCI rated the hindrance they perceived due to spasticity in daily living at the start of active rehabilitation (t1), 3 months later (t2), at discharge (t3) and 1 year after discharge (t4). Hindrance was dichotomized into absent or negligible and present. Multilevel regression analyses were performed to determine the course of functional hindrance due to spasticity and its associations with possible determinants-namely, age, gender, cause, lesion level, motor completeness, spasticity and anti-spasticity medication. Results: The percentage of individuals that indicated functional hindrance due to spasticity ranged from 54 to 62% over time and did not change significantly over time (Δt3t1 odds ratio (OR) = 0.85, P = 0.44; Δt3t2 OR = 1.20, P = 0.41; Δt3t4 OR = 0.91, P = 0.67). The percentage of individuals who experienced a lot of hindrance due to spasticity during specific activities ranged from 4 to 27%. The odds for experiencing functional hindrance due to spasticity were significantly higher for individuals with tetraplegia (OR = 2.17, P = 0.0001), more severe spasticity (OR = 5.51, Po0.0001) and for those using anti-spasticity medication (OR = 4.18, Po0.0001). INTRODUCTIONSpasticity is defined as 'disordered sensori-motor control, resulting from an upper motor neuron lesion, presenting as intermittent or sustained involuntary activation of muscles'. 1 The literature has shown that 65-78% of individuals with chronic spinal cord injury (SCI) have symptoms of spasticity. 2,3 It has the potential to negatively influence the quality of life through restricting activities of daily living, causing pain and contributing to the development of contractures. 4,5 In a sample of SCI survivors, the prevalence of problematic spasticity at 1, 3 and 5 years following SCI was 35%, 31% and 27%, respectively. 5 These findings agree with the observations of Levi et al. 6 and Sköld et al. 3 Adriaansen et al. 7 reported problematic spasticity in 28-34% of individuals with SCI 1-5 years after discharge from inpatient rehabilitation. However, these studies do not describe how hindrance due to spasticity develops in the early phase after SCI. More knowledge is necessary about the course of hindrance over time and which activities of daily living are most hindered by spasticity in order to improve the management of spasticity.The aim of the present study was to describe functional hindrance due to spasticity during inpatient rehabilitation and 1 year thereafter

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“…Spasticity can have influence on body functions and structures, 15 activities and participation. Our study focused on the influence of spasticity on activities.…”

Section: Discussionmentioning

confidence: 99%

Functional hindrance due to spasticity in individuals with spinal cord injury during inpatient rehabilitation and 1 year thereafter

et al. 2015

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“…Patients with contractures are likely to have pain [10,26,37], pressure ulcers [8], and cognitive impairment [26]. Contractures also can contribute to impaired function and activity limitations [5,12,14,16,19,26].…”

Section: Introductionmentioning

confidence: 99%

Stretching After Heat But Not After Cold Decreases Contractures After Spinal Cord Injury in Rats

Iwasawa

Nomura

Sakitani

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Contractures are a prevalent and potentially severe complication in patients with neurologic disorders. Although heat, cold, and stretching are commonly used for treatment of contractures and/or spasticity (the cause of many contractures), the sequential effects of these modalities remain unclear. Questions/purposes Using an established rat model with spinal cord injury with knee flexion contracture, we sought to determine what combination of heat or cold before stretching is the most effective for treatment of contractures derived from spastic paralyses and investigated which treatment leads to the best (1) improvement in the loss of ROM; (2) restoration of deterioration in the muscular and articular factors responsible for contractures; and (3) amelioration of histopathologic features such as muscular fibrosis in biceps femoris and shortening of the joint capsule. Methods Forty-two adolescent male Wistar rats were used. After spasticity developed at 2 weeks postinjury, each animal with spinal cord injury underwent the treatment protocol daily for 1 week. Knee extension ROM was measured with a goniometer by two examiners blinded to each other's scores. The muscular and articular factors contributing to contractures were calculated by measuring ROM before and after the myotomies. We quantitatively measured the muscular fibrosis and the synovial intima length, and observed the distribution of collagen of skeletal muscle. The results were confirmed by a blinded observer. Results The ROM of heat alone (34°± 1°) and cold alone (34°± 2°) rats were not different with the numbers available from that of rats with spinal cord injury (35°± 2°) (p = 0.92 and 0.89, respectively). Stretching after heat (24°± 1°) was more effective than stretching alone (27°± 3°) at increasing ROM (p \ 0.001). Contrastingly, there was no difference between stretching after cold (25°± 1°) and stretching alone (p = 0.352). Stretching after heat was the most effective for percentage improvement of muscular (29%) and articular (50%) factors of contractures. Although quantification of muscular fibrosis in the rats with spinal cord injury (11% ± 1%) was higher than that of controls (9% ± 0.4%) (p = 0.01), no difference was found between spinal cord injury and each treatment protocol. The total synovial intima length of rats with spinal cord injury (5.9 ± 0.2 mm) became shorter than those of the controls (7.6 ± 0.2 mm) (p \ 0.001), and those of stretching alone (6.9 ± 0.4 mm), stretching after heat (7.1 ± 0.3 mm), and stretching after cold (6.7 ± 0.4 mm)

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“…Although rehabilitation for these patients began as soon as possible following injury, three patients with a grade A had severe contracture in their shoulders that was accompanied by pain. Diong et al 18 reported that the incidence of shoulder contracture 1 year after spinal cord injury was 43%. This type of contracture is associated with CSCI, and injury at C3-4 might result in shoulder pain, as well as muscle weakness.…”

Section: Discussionmentioning

confidence: 99%

The potential for functional recovery of upper extremity function following cervical spinal cord injury without major bone injury

et al. 2013

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Study Design: This was a retrospective observational study. Objectives: The objectives were to describe the prognosis of upper extremity function following cervical spinal cord injury (CSCI), and to identify prognostic factors for functional recovery. Setting: Spinal Injuries Center, Japan. Methods: Sixty patients with C3-4 CSCI without major bone injury participated in the study. Patients were treated nonsurgically and evaluated using the American Spinal Injury Association (ASIA) scales for the upper and lower extremities, their residual cervical motor functions, the modified Frankel grade and an upper extremity function scale. We compared the findings for the upper extremity function scale at 6 months with those for the residual cervical motor functions and modified Frankel grade obtained 3 days after injury. Results: Most patients with CSCI who could flex their hip and knee from a supine position (95%) or who showed some active elbow extension (86%) 3 days after their injury could use a spoon at 6 months. We compared patients who used their fingers at 6 months to those who could not, and observed significant differences in age and ASIA scores for the upper and lower extremities obtained 3 days after injury. A strong correlation was observed between the initial motor scores and the extent of functional recovery at 6 months. Conclusion: Hip and knee flexion from the supine position and elbow extension 3 days after injury significantly predicted a positive prognosis for upper extremity function. Younger age and higher ASIA motor scores obtained 3 days after injury were factors associated with neurological recovery.

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Incidence and predictors of contracture after spinal cord injury—a prospective cohort study

Cited by 81 publications

References 23 publications

Functional hindrance due to spasticity in individuals with spinal cord injury during inpatient rehabilitation and 1 year thereafter

Functional hindrance due to spasticity in individuals with spinal cord injury during inpatient rehabilitation and 1 year thereafter

Stretching After Heat But Not After Cold Decreases Contractures After Spinal Cord Injury in Rats

The potential for functional recovery of upper extremity function following cervical spinal cord injury without major bone injury

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