AA

Key Points

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Spasticity Outcome Measures

  • Although consensus has not yet been reached on clinically meaningful, feasible and effective outcome measures relevant to the treatment of spasticity and patient reported outcomes, development and inclusion of such a multidimensional test battery is required for understandable interpretations of and between future studies.

Passive Movement-based Approaches for Reducing Spasticity

  • Hippotherapy may result in short-term reductions in spasticity.
  • A combination of neural facilitation techniques and Baclofen may reduce spasticity.
  • Rhythmic passive movements may produce short-term reductions in spasticity.
  • Prolonged standing or other methods of producing muscle stretch may result in reduced spasticity.
  • Electrical passive pedaling systems may result in short-term reduction in spasticity.

Active Movement-based Approaches for Reducing Spasticity

  • Active exercise interventions such as hydrotherapy and FES-assisted cycling and walking may produce short-term reductions in spasticity.

Direct Muscle Stimulation for Reducing Spasticity

  • Electrical stimulation applied to individual muscles may produce a short term decrease in spasticity. There is also some concern that long-term use of electrical stimulation may increase spasticity.

Various Forms of Afferent Stimulation for Reducing Spasticity

  • Ongoing transcutaneous electrical nerve stimulation (TENS) programs result in short-term reductions in spasticity which may last for up to 24 hours.
  • Penile vibration and rectal probe stimulation may be effective at reducing lower limb muscle spasticity for several hours.
  • Other forms of afferent stimulation including massage, cryotherapy, helium-neon irradiation, and whole-body vibration may result in immediate spasticity reduction but require more research to examine long-term effects.

Direct Spinal Cord and Transcranial Magnetic Stimulation

  • Spinal cord stimulation may provide spasticity relief over a few months but long-term effectiveness and cost-effectiveness is less certain.
  • Repetitive transcranial magnetic stimulation may provide spasticity relief over the short-term but long-term effectiveness is unknown.

Neuro-Surgical Interventions for Spasticity

  • Dorsal longitudinal T-myelotomy may result in reduced spasticity.

Oral Baclofen

  • Oral baclofen reduces muscle spasticity in people with SCI.

Intrathecal Baclofen

  • Bolus or long-term intrathecal baclofen decreases spasticity and may improve functional outcomes with low complication rates and is a cost effective intervention.

Effect of Medications Other than Baclofen

  • Tizanidine may be useful in treating SCI spasticity.
  • Clonidine may be effective in treating SCI spasticity but more evidence is required to support its routine use.
  • The usefulness of 4-Aminopyridine in the treatment of SCI spasticity requires confirmation through additional well-designed studies.
  • Cyproheptadine may be useful in treating SCI spasticity but requires additional confirmatory research.
  • Gabapentin may be useful in treating SCI spasticity but requires additional confirmatory research.
  • Orphenadrine citrate may reduce spasticity in SCI but additional confirmatory research is needed.
  • The use of L-threonine in the treatment of SCI spasticity requires confirmation through additional well-designed studies.
  • Continued use of diazepam and dantrolene would benefit from controlled comparison studies.

Cannabinoids

  • Oral detra-9-tetrahydrocannabinol (dronabinol) may help to reduce spasticity but requires additional evidence from controlled studies.
  • Nabilone has been shown to be effective in reducing spasticity but additional research is needed.

Focal Neurolysis

  • Botulinum neurotoxin appears to improve focal muscle spasticity in people with SCI.
  • Phenol block may improve pain, range of motion and function related to shoulder spasticity in individuals with tetraplegia.
  • Phenol block may reduce hip adductor spasticity in individuals with paraplegia and tetraplegia.