Optimizing the Management of Disabling Spasticity Following Spinal Cord Damage: The Ability Network—An International Initiative

Burns, Anthony S.; Lanig, Indira S.; Grabljevec, Klemen; New, Peter W; Bensmaïl, Djamel; Ertzgaard, Per; Nene, A.V.

doi:10.1016/j.apmr.2016.04.025

Cited by 37 publications

(22 citation statements)

References 53 publications

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“…It summarizes the deliberations and findings of the Outcomes and Access working group of the Ability Network (AN), an international panel of clinical experts with the overarching goal of addressing challenges and barriers to optimizing the management of disabling spasticity in people with SCD. 1 While there have been many different definitions cited in the medical literature, the Ability Network (including the authors) endorses the definition previously proposed by Pandyan et al: "disordered sensori-motor control, resulting from an upper motor neuron lesion, presenting as intermittent or sustained involuntary activation of muscles." 1,2 The severity of spasticity varies and while it is not always problematic, it can be disabling, with profound effects on functioning, wellbeing and healthrelated quality of life (HRQoL).…”

Section: Introductionmentioning

confidence: 92%

“…1 While there have been many different definitions cited in the medical literature, the Ability Network (including the authors) endorses the definition previously proposed by Pandyan et al: "disordered sensori-motor control, resulting from an upper motor neuron lesion, presenting as intermittent or sustained involuntary activation of muscles." 1,2 The severity of spasticity varies and while it is not always problematic, it can be disabling, with profound effects on functioning, wellbeing and healthrelated quality of life (HRQoL). 1,[3][4][5][6][7][8] The Ability Network has defined disabling spasticity as "spasticity which is perceived by the individual or caregivers as hindering body function, activities, and/or participation."…”

Section: Introductionmentioning

confidence: 92%

“…1,2 The severity of spasticity varies and while it is not always problematic, it can be disabling, with profound effects on functioning, wellbeing and healthrelated quality of life (HRQoL). 1,[3][4][5][6][7][8] The Ability Network has defined disabling spasticity as "spasticity which is perceived by the individual or caregivers as hindering body function, activities, and/or participation." 1 Following SCD, a routine part of the initial and ongoing assessment of spasticity is the determination of its clinical and functional impact.…”

Section: Introductionmentioning

confidence: 99%

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A review and evaluation of patient-reported outcome measures for spasticity in persons with spinal cord damage: Recommendations from the Ability Network – an international initiative

Ertzgaard

Nene

Kiekens

et al. 2019

The Journal of Spinal Cord Medicine

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Context: Patient-reported outcome measures (PROMs) are valuable for capturing the impact of spasticity on health-related quality of life (HRQoL) in persons with spinal cord damage (SCD) and evaluating the efficacy of interventions. Objective: To provide practical guidance for measuring HRQoL in persons with spasticity following SCD. Methods: Literature reviews identified measures of HRQoL and caregiver burden, utilized in studies addressing spasticity in SCD. Identified measures were evaluated for clinical relevance and practicality for use in clinical practice and research. The PRISM, SCI-SET, EQ-5D and SF-36 instruments were mapped to the International Classification of Functioning, Disability and Health (ICF). The PRISM and SCI-SET were evaluated using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. Results: Two spasticity-specific, five generic, and four preference-based measures were identified. ICF mapping and the COSMIN checklist supported the use of the PRISM and SCI-SET in SCD. The SF-36 is considered the most useful generic measure; disability-adapted versions may be more acceptable but further studies on psychometric properties are required. The SF-36 can be converted to a preference-based measure (SF-6D), or alternatively the EQ-5D can be used. While no measures specific to caregivers of people with SCD were identified, the Caregiver Burden Scale and the Zarit Burden Interview are considered suitable. Conclusion: Recommended measures include the PRISM and SCI-SET (condition-specific), SF-36 (generic), and Caregiver Burden Scale and Zarit Burden Interview (caregiver burden). Consideration should be given to using condition-specific and generic measures in combination; the PRISM or SCI-SET combined with SF-36 is recommended.

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Section: Introductionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

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A review and evaluation of patient-reported outcome measures for spasticity in persons with spinal cord damage: Recommendations from the Ability Network – an international initiative

Ertzgaard

Nene

Kiekens

et al. 2019

The Journal of Spinal Cord Medicine

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“…Spasticity has both positive and negative effects. The term "disabling spasticity" has been used when people perceive that spasticity limits their activities in daily life (8), and is therefore a target for intervention. Evidence pointing to the relationship between spasticity and functioning has shown significant interference with daily activities in people with more severe, self-reported spasticity compared with people with no or only mild spasticity (9).…”

Section: Outcome Measuresmentioning

confidence: 99%

Impact of spasticity on functioning in spinal cord injury: an application of graphical modelling

Ehrmann¹,

Mahmoudi²,

Prodinger³

et al. 2020

J Rehabil Med

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Spasticity is one of the most common complications of spinal cord injury. It influences limitations in functioning. Comprehensive evidence on the impact of spasticity on all domains of functioning may be beneficial to optimize rehabilitation interventions aimed at reducing the effects of spasticity. This is the first application of graphical modelling to study and visualize the impact of moderateto-severe spasticity on functioning in people living with spinal cord injury. The results show that chronic pain, contractures, tiredness, doing housework, and respiratory functions were the functioning domains associated with spasticity. These are therefore the top 5 potential targets for interventions to improve the experience of spasticity. In addition, the level and completeness of lesions should be considered when studying spasticity in relation to all domains of functioning. These results should be used as a basis for studies aiming to optimize rehabilitation interventions in people with moderate-to-severe spasticity. Objective: To identify the impact of moderate-to-severe spasticity on functioning in people living with spinal cord injury. Design: Secondary analysis of cross-sectional survey data using graphical modelling. Subjects: Individuals (n = 1,436) with spinal cord injury aged over 16 years with reported spasticity problems. Methods: Spasticity and 13 other impairments in body functions were assessed using the spinal cord injury Secondary Conditions Scale. Impairments in mental functions were assessed using the Mental Health subscale of the 36-item Short Form (SF-36). Independence in activities was measured with the Spinal Cord Injury Independence Measure Self-Report. Restrictions in participation were measured with the Utrecht Scale for Evaluation Rehabilitation-Participation. Results: Fifty-one percent of participants reported moderate-to-severe spasticity. Graphical modelling showed that Chronic pain, Contractures, Tiredness, Doing housework, and Respiratory functions were associated with spasticity and were the top 5 potential targets for interventions to improve the experience of spasticity. The associations and intervention targets were dependent on the level and completeness of the lesion. Conclusion: This is the first application of graphical modelling in studying spasticity in people living with spinal cord injury. The results can be used as a basis for studies aiming to optimize rehabilitation interventions in people with moderate-to-severe spasticity.

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“…Numerous definitions for spasticity exist (5), although that provided by Pandyan et al (6) has been advocated during recent years: "disordered sensorimotor control resulting from an upper motor neuron lesion, presenting as intermittent or sustained involuntary activation of muscles". Spasticity is a common complication of upper motor neurone syndrome, and can occur when areas controlling movement are damaged, most often by brain injury disorders, such as or cerebral palsy (CP), traumatic brain injury (BI) or stroke, or by spinal cord disorders, such as spinal cord injury (SCI) or multiple sclerosis (MS) (7).…”

mentioning

confidence: 99%

Efficacy and safety of oral baclofen in the management of spasticity: A rationale for intrathecal baclofen

Ertzgaard¹,

Campo²,

Calabrese³

2017

J Rehabil Med

110

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Oral baclofen has long been a mainstay in the management of spasticity. This review looks at the clinical evidence for the efficacy and safety of oral baclofen in patients with spasticity of any origin or severity, to determine whether there is a rationale for the use of intrathecal baclofen. Results suggest that oral baclofen may be effective in many patients with spasticity, regardless of the underlying disease or severity, and that it is at least comparable with other antispasmodic agents. However, adverse effects, such as muscle weakness, nausea, somnolence and paraesthesia, are common with oral baclofen, affecting between 25% and 75% of patients, and limiting its usefulness. Intrathecal baclofen may be an effective alternative as the drug is delivered directly into the cerebrospinal fluid, thus bypassing the blood-brain barrier and thereby optimizing the efficacy of baclofen while minimizing drug-related side-effects. Intrathecal baclofen is a viable option in patients who experience intolerable side-effects or who fail to respond to the maximum recommended dose of oral baclofen.

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Optimizing the Management of Disabling Spasticity Following Spinal Cord Damage: The Ability Network—An International Initiative

Cited by 37 publications

References 53 publications

A review and evaluation of patient-reported outcome measures for spasticity in persons with spinal cord damage: Recommendations from the Ability Network – an international initiative

A review and evaluation of patient-reported outcome measures for spasticity in persons with spinal cord damage: Recommendations from the Ability Network – an international initiative

Impact of spasticity on functioning in spinal cord injury: an application of graphical modelling

Efficacy and safety of oral baclofen in the management of spasticity: A rationale for intrathecal baclofen

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