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Spasticity

Key Points

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.

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