A multidimensional test battery of Spasticity Outcome Measures is needed for understandable interpretations of and between future studies.
Passive Movement-based Approaches for Reducing Spasticity
Short-term reductions in spasticity may be achieved by a variety of passive movement-based approaches (hippotherapy, neural facilitation combinations, rhythmic passive movements, prolonged standing of other methods of muscle stretching, and electrical passive pedaling systems.
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
Short-term reductions in spasticity may be achieved by various forms of afferent stimulation (ongoing (TENS) transcutaneous electrical nerve stimulation programs, penial vibration and rectal probe stimulation, massage, cryotherapy, helium-neon irradiation, and whole-body vibration).
Direct Spinal Cord and Transcranial Magnetic Stimulation
Short-or medium-term spasticity relief may be possible with repetitive transcarinal magnetic stimulation or spinal cord stimulation, respectively.
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
A variety of medications, other than baclofen, may be effective in treating SCI related spasticity (Tizanidine, Clonidine, cyproheptadine, gabapentin, orphenadrine citrate, and L-threonine).
The usefulness of 4-Aminopyridine 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) and Nabilone may help to reduce spasticity.
Botulinum neurotoxin appears to improve focal muscle spasticity in people with SCI.
Phenol blocks may assist in treating shoulder and hip adductor spasticity in individuals with SCI.