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Key Points

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Introduction

  • 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.

Non-Pharmacological Interventions for 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 exercise interventions such as hydrotherapy, FES-assisted cycling and walking and robot-assisted exercise (including specific exercises combined) may produce short-term reductions in spasticity.
  • Electrical stimulation applied to individual muscles may produce a short term decrease in spasticity; however, there is also some concern that long-term use of electrical stimulation may increase spasticity.
  • Ongoing (TENS) transcutaneous electrical nerve stimulation programs result in short-term reductions in spasticity which may last for up to 24 hours.
  • Use of TENS and standard physical therapy showed a reduction in clinical spasticity in the subacute phase of rehabilitation.
  • Penile vibration and rectal probe stimulation may be effective at reducing lower limb muscle spasticity for several hours. 
  • Other forms of afferent stimulation including taping, massage, cryotherapy, helium-neon irradiation, whole-body vibration, and galvanic vestibular stimulation may result in immediate spasticity reduction but require more research to understand effects and intervention parameters.
  • Spinal cord stimulation may provide spasticity relief over a few months but long-term effectiveness and feasibility is less certain.
  • Repetitive transcranial magnetic stimulation may provide spasticity relief and improve walking speed over the short-term but long-term effectiveness is unknown.
  • Treatment with intermittant theta-burst stimulation is likely to reduce upper extremity spasticity for up to 1 week.

Neuro-Surgical Interventions for Spasticity

  • Dorsal longitudinal T-myelotomy may result in reduced spasticity.
  • Human neural stem cell transplantation in chronic SCI does not reduce spasticity secondary to SCI.
  • Intrathecal injection of autologous mesenchymal stem cells in people with chronic SCI is unlikely to result in persistent spasticity reduction.

Pharmacological Interventions for Spasticity

  • Oral baclofen reduces muscle spasticity in people with SCI.
  • Oral baclofen is inferior to botulinumtoxin A injection and oral tolperisone by 6 weeks of spasticity treatment in people with SCI.
  • Diazepam is effective for the treatment of spasticity secondary to SCI.
  • Bolus or long-term intrathecal baclofen decreases spasticity and may improve functional outcomes with low complication rates and is a cost-effective intervention.
  • Tizanidine is likely useful in treating SCI spasticity.
  • Clonidine may be effective in treating SCI spasticity but more evidence is required to support its routine use.
  • Fampridine-SR is not significantly efficacious for the treatment of spasticity in chronic SCI.
  • Intravenous Fampridine is not significantly efficacious for the treatment of spasticity in chronic SCI.
  • Cyproheptadine may be useful in treating SCI spasticity but requires additional confirmatory trials using rigorous study design.
  • Gabapentin may be useful in treating SCI spasticity but requires additional confirmatory research.
  • TCM, intravenous orphenadrine cirate, riluzole, and L-threonine may be effective in treating SCI-related spasticity.
  • Levitiracetam, diazepam, dantrolene and naloxone may not be effective for treating SCI-related spasticity, but would benefit from confirmatory studies.
  • Nabilone has been shown to be effective in reducing spasticity but additional research is needed.
  • Oral detra-9-tetrahydrocannabinol (dronabinol) may help to reduce spasticity but requires additional evidence from controlled studies.
  • Botulinum neurotoxin may 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.