Spasticity after traumatic spinal cord injury: Nature, severity, and location

Sköld, Camilla; Levi, Richard; Seiger, Åke

doi:10.1016/s0003-9993(99)90329-5

Cited by 277 publications

(253 citation statements)

References 22 publications

Supporting

Mentioning

224

Contrasting

Unclassified

Order By: Relevance

“…11,12 One of the greatest challenges facing the SCI clinician and rehabilitation team is evaluating the effectiveness of drug and/or rehabilitation interventions intended to ameliorate spasticity. The mainstays of treatment for spasticity include rehabilitation therapies such as hot or cold application, stretching, positioning and splinting to prevent contracture, in addition to oral and or injectable pharmacologic treatments and neurosurgical procedures.…”

Section: Spasticity Treatmentmentioning

confidence: 99%

Modified Ashworth scale reliability for measurement of lower extremity spasticity among patients with SCI

2009

View full text Add to dashboard Cite

Study design: Observational study. Objectives: To report the intra-rater (one rater), inter-rater (two raters) and inter-session (one subject, sessions 1-5) reliability of lower extremity modified Ashworth scale (MAS) scores among patients with chronic spinal cord injury (SCI). Setting: Tertiary Academic Rehab Centre in Toronto, Canada. Methods: MAS scores of 20 subjects with chronic SCI (C5-T10 AIS A-D412 months) were recorded for the hip abductors and adductors, knee flexors and extensors, and ankle plantar and dorsiflexors. MAS scores were assessed by two blinded raters (A and B) at the same time of day, weekly for 5 weeks using standardized test positions, a one-cycle per second metronome, with ratings recorded on the second cycle. MAS score reproducibility [intra-rater, inter-rater] were calculated using Cohen's Kappa. Intraclass correlation coefficients (ICCs) were calculated to determine inter-session (trials 1-5) reliability; Kappa values X0.81 and ICC values X0.75 were desired. Results: Intra-rater reliability was fair to almost perfect (0.2oko1.0) and differed between raters. Inter-rater reliability was poor-to-moderate (ko0.6) for all muscle groups. Inter-session reliability for a single rater was fair-to-good (0.4oICCo0.75) for all muscle groups. Conclusions: MAS was not reliable as an intra-rater tool for all raters, and showed poor inter-rater and modest inter-session reliability. MAS has inadequate reliability for determining lower extremity spasticity between raters (inter-rater) or over time (inter-session). It is recommended that the rehabilitation science community seek alternative measures for quantifying spasticity.

show abstract

Section: Spasticity Treatmentmentioning

confidence: 99%

Modified Ashworth scale reliability for measurement of lower extremity spasticity among patients with SCI

2009

View full text Add to dashboard Cite

show abstract

“…[1][2][3] The most commonly cited definition for spasticity is that published by Lance in 1980: 4 'Spasticity is a motor disorder characterized by a velocitydependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex, as one component of the upper motoneuron syndrome'. There remains, however, discrepancy in the literature about the definition of spasticity; whereas some authors include symptoms such as clonus, hyperactive tendon reflexes, and spasms within the umbrella term 'spasticity', 1,[5][6][7] others discuss these same symptoms as related to but separate from spasticity, which is defined by these authors as increased muscle tone. 3,[8][9][10][11] Decq 2 recently has suggested the use of a modified definition, whereby spasticity, in general, is defined as a symptom of the upper motor neuron syndrome characterized by an exaggeration of the stretch reflex secondary to hyperexcitability of spinal reflexes.…”

Section: Introductionmentioning

confidence: 99%

Spasticity after spinal cord injury

2005

View full text Add to dashboard Cite

Symptoms of spasticity are often experienced by individuals with spinal cord injury (SCI) following a period of spinal shock and, in many cases, these symptoms negatively affect quality of life. Despite its prevalence, spasticity as a syndrome in the SCI population is not always managed effectively. This is likely due to the fact that the syndrome can have various presentations, each with their own specific etiology. This overview summarizes the symptoms and pathophysiology of the various presentations of spasticity in the SCI population and discusses the currently accepted management techniques. There is a need for a better understanding of the syndrome of spasticity as well as the development of a valid and reliable assessment tool.

show abstract

Section: Introductionmentioning

confidence: 99%

“…1,2 About one in three patients needs oral antispasmodic drugs to counter a loss of independence in their activities of daily living (ADL) or pain secondary to muscle contraction. 1,2 Intrathecal baclofen has been commonly used since 1984 in patients who are resistant to or who do not tolerate oral antispasmodic drugs. 3 The decision to implant a drug delivery system is usually taken after a positive test (two points diminution in Ashworth or Spasm frequency scale) obtained after a single injection of 50-100 mg of intrathecal baclofen.…”

Section: Introductionmentioning

confidence: 99%

Subdural catheter migration may lead to baclofen pump dysfunction

2003

View full text Add to dashboard Cite

Objectives: To report an unusual cause of intrathecal drug delivery failure in baclofen pump device. Study design: A case report of an SCI patient treated with intrathecal baclofen, presenting a drug withdrawal. Setting: Regional spinal cord injuries centre in Geneva (Switzerland). Methods: We present a case of a 38-year-old male with complete T9 spastic paraplegia for 15 years, treated with intrathecal baclofen for 11 years. He recently presented to our centre with a spastic hypertonic episode, associated with rhabdomyolysis. Results: Standard investigations were unrevealing. However, a CT scan performed after injecting a radio-opaque solution by the side port of the pump, showed an unexpected catheter migration into the subdural space. Surgical revision reversed withdrawal symptoms. Conclusions: Subdural catheter migration must be considered in the differential diagnosis of intrathecal drug delivery system failures. We recommend the use of the CT scan after contrast injection, to detect the localization of the distal catheter tip and confirm the normal diffusion into the subarachnoid space.

show abstract

Spasticity after traumatic spinal cord injury: Nature, severity, and location

Cited by 277 publications

References 22 publications

Modified Ashworth scale reliability for measurement of lower extremity spasticity among patients with SCI

Modified Ashworth scale reliability for measurement of lower extremity spasticity among patients with SCI

Spasticity after spinal cord injury

Subdural catheter migration may lead to baclofen pump dysfunction

Contact Info

Product

Resources

About