|Burns & Meythaler 2001 USA
Population: Age: 25-64 yr; Level of injury: C4-C7; Severity of injury: AIS A-D; Time since injury: 1.2-24 yr.
Intervention: Intrathecal baclofen.
Outcome Measures: Ashworth Scale, Spasm Frequency Scale, Reflex Scale.
1. Significant decline in UE hypertonia during 12 mo follow up period.
2. Average baseline Ashworth score was 2.4±1.1 compared to 1.8±1.0 at 12 mo (p<0.0001).
3. The average spasm score decreased from 2.3±1.6 to 0.5±0.9, not significant at p=0.2503 (Friedman test).
4. The difference was significant (p=0.0012 Wilcoxon signed rank test). UE reflexes, average baseline reflex score was 2.3±0.2 compared to 0.9±0.2 at 12 mo (p<0.0001 Friedman).
5. Dosage requirements increased during the 12-mo follow-up period, statistically significant (p<0.0001, Friedman).
6. Statistically significant declines in upper extremity spasm scores (1.8 points, p=0.012), reflex scores (1.4 points, p<0.0001) and Ashworth scores (0.6 points, p<0.0001) for the 1-yr follow-up period.
|Bunday et al. 2014
Prospective Controlled Trial
Population: SCI population (n=23): Mean age: 51.9±11.8 yr; Gender: males=21, females=2; Level of injury: C2-C8=23; Severity of Injury: AIS-A=2, AIS-B=1, AIS-C-D=2.
Age matched controls (n=20): Mean age: 45±16.2 yr; Gender: males=8, females=12.
Intervention: Participants performed tasks requiring precision grip and index finger abduction while noninvasive cortical and cervicomedullary stimulation allowed motor evoked potentials (MEPs). The activity in intracortical and subcortical pathways were examined.
Outcome Measures: EMG activity, F-wave amplitude and persistence, Suppression of voluntary EMG by subthreshold TMS (svEMG).
1. Significant effect of group (p=0.001) but not task (p=0.21) or interaction (p=0.19) on FDI mean rectified EMG activity.
2. EMG activity increased in SCI patients taking baclofen (SCIBac) (p=0.001) and patients who never took baclofen (SCINo-Bac) (p=0.01) compared with controls; no significance between patient groups (p=0.95).
3. Both SCI and control groups maintained similar EMG activity in the FDI muscle during precision grip and index finger abduction (p=0.21).
4. During index finger abduction, controls (p=0.01), SCIBac (p<0.001) and SCINo-Bac (p=0.04) more EMG activity in FDI compared to APB at all Transcranial magnetic stimulation (TMS) intensities.
5. Significant decrease in MEP size in controls (p<0.001) and SCIBac (p=0.001) during precision grip compared with index finger abduction.
6. At increasing stimulus intensities, MEP sizes in control subjects were significantly larger than SCINo-Bac and SCIBac (p<0.001).
7. FDI cervicomedullary MEPs decreased during precision grip compared with index finger abduction in controls (p<0.01) and SCIBac (p<0.01) but not SCINo-Bac (p=0.57).
8. No effect of task, group or their interaction on F-wave amplitude or F-wave persistence (p>0.05).
9. Significant effect of task (p<0.001), but not group (p=0.39) or their interaction (p=0.20) on svEMG.
10. Significant decrease in svEMG area during precision grip compared with index finger abduction in controls (p=0.03), SCIBac (p=0.02) and SCINo-Bac (p=0.02).