Spasticity, defined as “disordered sensori-motor control, resulting from an upper motor neuron lesion, presenting as intermittent or sustained involuntary activation of muscle” (Pandyan et al. 2005), is a frequent condition associated with SCI with as many as 78% of persons with chronic SCI reporting spasticity (Adams and Hicks 2005). Spasticity may not worsen with age or time, however uncontrolled spasticity has been suggested as having an impact on emotional adaptation, dependency, secondary health problems and environmental integration (Krause 2007). Physical activity interventions have demonstrated decreased spasticity in persons with SCI and the reader is referred to SCIRE: Spasticity Following Spinal Cord Injury (Hsieh et al. 2010) for more information on this topic. In the following section, we present those specific evidence-based statements and bottom-line conclusions from this chapter related to physical activity.
Conclusions – From SCIRE:Spasticity Following SCI
Interventions Based on Passive Movement or Stretching
There is level 1 evidence from a single study that passive ankle movements may not reduce lower limb muscle spasticity in persons with initial mild spasticity.
There is level 2 evidence from a single study supported by level 4 evidence from another study that hippotherapy may reduce lower limb muscle spasticity immediately following an individual session.
There is level 2 evidence that electrical passive pedaling systems have an effect on spasticity and hip, knee and ankle range of motion.
There is limited level 1 evidence from a single study that a combination of a 6 week course of neural facilitation techniques (Bobath, Rood and Brunnstrom approaches) and Baclofen may reduce lower limb muscle spasticity with a concomitant increase in ADL independence. More research is needed to determine the relative contributions of these therapies.
There is level 4 evidence from a single study that rhythmic, passive movements may result in a short-term reduction in spasticity.
There is level 4 evidence from a single study that externally applied forces or passive muscle stretch (applied in assisted standing programs) may result in short-term reductions in spasticity. This is supported by individual case studies and anecdotal reports from survey-based research.
- 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.
Interventions Based on Active Movement (Including FES-assisted Movement
There is level 2 evidence from a single study (Kesiktas et al. 2004) that hydrotherapy is effective in producing a short-term reduction in spasticity.
There is level 2 evidence from a single study that single bouts of FES-assisted cycling ergometry and similar passive cycling movements are effective in reducing spasticity over the short-term with FES more effective than passive movement.
There is level 4 evidence from three studies (Granat et al. 1993; Thoumie et al. 1995; Mirbagheri et al. 2002) that a program of FES-assisted walking acts to reduce ankle spasticity in the short-term (i.e., <24 hours).
There is no evidence describing the length and time course of the treatment effect related to spasticity for hydrotherapy or FES-assisted walking.
Active exercise interventions such as hydrotherapy and (FES) functional electrical stimulation-assisted walking may produce short-term reductions in spasticity.