Spasticity changes in SCI following a dynamic standing program using the Segway

Abstract

Study design: A pilot prospective pre-and post-intervention study. Objectives: To determine whether a dynamic standing program using the Segway Personal Transporter results in any measurable physiological effects in individuals with spinal cord injury (SCI) using both qualitative and quantitative measures of spasticity, pain and fatigue. Setting: International Collaboration of Repair Discoveries (ICORD) Research Centre, Vancouver, BC, Canada. Methods: Eight individuals with SCI ASIA (American Spinal Injury Association) A-D, who could stand with or without the assistance of bracing or supports, participated in a 4-week dynamic standing program using a Segway (3 per week, 30-min sessions). The main outcome was spasticity as measured by the Modified Ashworth Scale (MAS). Secondary measures included the SCI-Spasticity Evaluation Tool, Pain Outcomes Questionnaire, and Fatigue Severity Scale. Results: The dynamic standing sessions were associated with immediate improvements in spasticity (MAS) (Po0.001) and selfreported pain (Po0.05). Fatigue levels decreased, however this was not significant. There is little evidence to suggest that these beneficial outcomes may have lasting effects. Conclusions: Dynamic standing on the Segway may be effective for short-term spasticity reduction and decreased pain and fatigue. Future work should examine a larger sample size and help to propose mechanisms for potential reductions in spasticity.

Weakened rate-dependent depression of Hoffmann’s reflex and increased motoneuron hyperactivity after motor cortical infarction in mice

“…50, 51, 52, 53 Apparent spastic behavior was not detected in our model, which may be due to the lack of an appropriate parameter for assessing spastic behavior in rodents. Given that we did not clearly observe spastic behavior, we are currently trying to detect abnormal muscle contractions or neuromuscular junction changes using morphological analyses.…”

Does regular standing improve bowel function in people with spinal cord injury? A randomised crossover trial

“…However, beliefs about the therapeutic effects of standing on spasticity are primarily based on the results of surveys, case series and case reports. [4][5][6]8,[12][13][14] There are as yet no high-quality trials that have provided convincing evidence that standing decreases spasticity. We therefore included spasticity as a secondary outcome to further explore this issue.…”

“…Of interest to this trial is not only the claim that regular standing improves bowel function but also that it reduces spasticity. [4][5][6]8,[12][13][14] It is believed that the stretch associated with standing dampens the reflex arc. There is some interim evidence to support this belief particularly from studies showing an immediate decrease in spasticity with one-off stretches.…”

“…However, there is no high-quality trial demonstrating lasting effects of standing on spasticity. [4][5][6]8,[12][13][14] It is important to clarify the therapeutic effects of standing because it is a time consuming and expensive intervention when continued on a regular basis over the course of an individual's life. The cost is not only associated with providing people with standing equipment, but more notably providing people with access to carers who can help them use the equipment.…”

Static standing, dynamic standing and spasticity in individuals with spinal cord injury

“…Individuals with different functional levels and varying degrees of strength, range of motion and balance found that they could easily and safely drive the Segway. 10 In a small pilot study of eight individual with SCI, Boutilier et al 11 showed that spasticity decreased significantly immediately after using a Segway as measured by the Modified Ashworth Scale (MAS); however, no long-term benefits were observed over a month of use.…”