Key Points

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Spasticity Outcome Measures

  •  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

  • 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

  • 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.

Focal Neurolysis

  • 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.