Determining Impact of Treatment
During initial inpatient rehabilition, spasticity that was not optimally managed was found to be, after pain and fatigue, a primary medical reason for increased length of stay (Dijkers & Zanca 2013; Hammond et al. 2013). Van Cooten et al. (2015) postulate that early, active rehabilitation would serve to reduce functional hindrance due to spasticity. Identification of specific spasticity components, during the subacute and chronic stages of SCI, that impact directly on gait, lower limb muscle function and activities of daily living could also be helpful in the refinement and customization of ongoing neurorehabilitation treatment strategies (Bravo-Esteban et al. 2013).
Spasticity in SCI varies with location and degree depending on the injury pathophysiology. Not all spasticity is bad and for this reason, an assessment of treatment goals must be considered with various management strategies and cost factors in mind. Sometimes, increased spasticity is beneficial for transfers and mobility, and the reduction of tone may negatively impact those activities of daily living. For example, in the acute rehabilitation setting, the absence of spasticity was an independent risk factor for the development of deep vein thrombosis (Do et al. 2013).
The goal should not be to modify the excitability and rigorousness of reflexes, but to overcome functional impairments related to “spasticity” (Dietz 2000). Therefore, the decision to treat “spasticity” should not only be based on the findings gained by the examination in passive (lying bed, sitting in the wheelchair) but also in active conditions (like walking, doing transfer etc.). As well, spasticity can be protective against skeletal muscle atrophy that in turn could indirectly affect functional independence, ambulation and incidence of fracture (Gorgey & Dudley 2008). Spasticity has also been reported to increase glucose uptake and thereby reduce the risk of diabetes in SCI (Bennegard & Karlsson 2008). Furthermore, recent reports identifying spasticity related enhancement/detraction of sexual activity in males/females respectively (Anderson et al. 2007a; Anderson et al. 2007b), again exemplifies the importance of individualized treatment choices. Incrementally applying the less invasive and cost-efficient treatments, as is common practice (Kirshblum 1999), will likely lead to a combination of treatments necessary to achieve the most successful outcome specific for each individual. Simultaneously with the completion of an assessment that clearly delineates the treatment goals, objective measures of spasticity that include individual reported outcomes are important to identify in order to confidently monitor the success of treatment choice(s). Spasticity treatment as it pertains to the various domains of everyday life should be considered (Mahoney et al. 2007).
