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 reduces muscle spasticity in people with SCI.
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.
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.
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.