Abstract
Optimizing the treatment of disabling spasticity in persons with spinal cord damage
is hampered by a lack of consensus regarding the use of acceptable definitions of
spasticity and disabling spasticity, and the relative absence of decision tools such
as clinical guidelines and concise algorithms to support decision-making within the
broader clinical community. Many people with spinal cord damage are managed outside
specialist centers, and variations in practice result in unequal access to best practice
despite equal need. In order to address these issues, the Ability Network—an international
panel of clinical experts—was initiated to develop management algorithms to guide
and standardize the assessment, treatment, and evaluation of outcomes of persons with
spinal cord damage and disabling spasticity. To achieve this, consensus was sought
on common definitions through facilitated, in-person meetings. To guide patient selection,
an in-depth review of the available tools was performed and expert consensus sought
to develop an appropriate instrument. Literature reviews are guiding the selection
and development of tools to evaluate treatment outcomes (body functions, activity,
participation, quality of life) as perceived by people with spinal cord damage and
disabling spasticity, and their caregivers and clinicians. Using this approach, the
Ability Network aims to facilitate treatment decisions that take into account the
following: the impact of disabling spasticity on health status, patient preferences,
treatment goals, tolerance for adverse events, and in cases of totally dependent persons,
caregiver burden.
Keywords
List of abbreviations:
ICF (International Classification of Functioning, Disability and Health), ITB (intrathecal baclofen), QOL (quality of life)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Reducing clinical variations with clinical pathways: do pathways work?.Int J Qual Health Care. 2003; 15: 509-521
- Spasticity after spinal cord injury.Spinal Cord. 2005; 43: 577-586
- Spinal cord injuries in young children: a review of children injured at 5 years of age and younger.Dev Med Child Neurol. 2012; 54: 1138-1143
- Incidence of skeletal fractures after spinal cord injury.Bone. 2012; 50: S194
- Three-year study of spinal cord injury outcomes and related secondary complications in a tertiary centre—a retrospective analysis.Arch Med Sci. 2009; 5: 190-194
- Non-traumatic spinal cord lesions: epidemiology, complications, neurological and functional outcome of rehabilitation.Spinal Cord. 2009; 47: 307-311
- Nontraumatic spinal cord injury: demographic characteristics and complications.Arch Phys Med Rehabil. 2002; 83: 996-1001
- Secondary conditions in a community sample of people with spinal cord damage.J Spinal Cord Med. 2016 Feb 23; ([Epub ahead of print])
- From spinal shock to spasticity: neuronal adaptations to a spinal cord injury.Neurology. 2000; 54: 1574-1582
- Management of spasticity after spinal cord injury: current techniques and future directions.Neurorehabil Neural Repair. 2010; 24: 23-33
- The Stockholm Spinal Cord Injury Study: 2. Associations between clinical patient characteristics and post-acute medical problems.Paraplegia. 1995; 33: 585-594
- Spasticity after traumatic spinal cord injury: nature, severity, and location.Arch Phys Med Rehabil. 1999; 80: 1548-1557
- Association of spasticity and life satisfaction after spinal cord injury.Spinal Cord. 2011; 49: 990-994
- The Stockholm Spinal Cord Injury Study: 1. Medical problems in a regional SCI population.Paraplegia. 1995; 33: 308-315
- Spasticity and spinal cord injury.2014 (Available at:) (Accessed August 10, 2014)
- Relationship between disability and health-related quality of life and caregiver burden in patients with upper limb poststroke spasticity.PMR. 2012; 4: 4-10
- Factors associated with risk for subsequent injuries after traumatic spinal cord injury.Arch Phys Med Rehabil. 2004; 85: 1503-1508
- An exploratory study of pressure ulcers after spinal cord injury: relationship to protective behaviors and risk factors.Arch Phys Med Rehabil. 2001; 82: 107-113
- Spasticity. Mechanisms and nursing care.Nurs Clin North Am. 1993; 28: 819-827
- Pain and spasticity after spinal cord injury: mechanisms and treatment.Spine (Phila Pa 1976). 2001; 26: S146-S160
- The management of focal spasticity.Clin Neuropharmacol. 2002; 25: 158-173
- Spasticity: pathophysiology and management.Orthopedics. 1993; 16: 801-811
- Long-term modification of spasticity.J Rehabil Med. 2003; 41: 60-65
- Missed therapy time during inpatient rehabilitation for spinal cord injury.Arch Phys Med Rehabil. 2013; 94: S106-S114
- Patterns of health care utilization in primary care settings and rehospitalization post-spinal cord injury.Arch Phys Med Rehabil. 2012; 93: e42
- Reasons for rehospitalization in patients with spinal cord injury: 5 years' experience.Int J Rehabil Res. 2006; 29: 71-76
- Time-course and determinants of spasticity during the first six months following first-ever stroke.J Rehabil Med. 2010; 42: 296-301
- Prevalence of disabling spasticity 1 year after first-ever stroke.Eur J Neurol. 2008; 15: 533-539
- Prevalence and treatment of spasticity reported by multiple sclerosis patients.Mult Scler. 2004; 10: 589-595
- The cerebral control of movement.Liverpool Univ Pr, Liverpool1966
- Symposium synopsis.in: Feldman R.G. Young R.R. Koella W.P. Spasticity: disorder of motor control. Year Book Medical Publishers, Chicago1980: 485-494
- Spasticity: a review.Neurology. 1994; 44: S12-S20
- Changes in hip spasticity and strength following selective dorsal rhizotomy and physical therapy for spastic cerebral palsy.Dev Med Child Neurol. 2002; 44: 220-226
- Classification and definition of disorders causing hypertonia in childhood.Pediatrics. 2003; 111: e89-e97
- Use of botulinum toxin type A in management of adult spasticity—a European consensus statement.J Rehabil Med. 2003; 35: 98-99
- Spasticity: clinical perceptions, neurological realities and meaningful measurement.Disabil Rehabil. 2005; 27: 2-6
- Considerations in the treatment of spasticity with intrathecal baclofen.Am J Health Syst Pharm. 2009; 66: S14-22
- Overview of common movement disorders.Continuum (Minneap Minn). 2010; 16: 13-48
- Spasticity: pathophysiology, evaluation and management.Pract Neurol. 2012; 12: 289-298
- A European Thematic Network to Develop Standardised Measures of Spasticity.2004 (Available at:) (Accessed July 17, 2016)
- Towards a common language for functioning, disability and health: ICF The International Classification of Functioning, Disability and Health.2002 (Geneva. Available at:) (Accessed August 10, 2014)
- ICF browser.2001 (Available at:) (Accessed November 26, 2014)
- Spasticity management in multiple sclerosis. Evidence-based management strategies for spasticity treatment in multiple sclerosis. Clinical practice guideline.J Spinal Cord Med. 2005; 28: 167-199
- Practice parameter: pharmacological treatment of spasticity in children and adolescents with cerebral palsy (an evidence-based review).Neurology. 2010; 74: 336-343
- Clinical management of spasticity.J Neurol Neurosurg Psychiatry. 2005; 76: 459-463
- Spasticity in children and young people with non-progressive brain disorders: management of spasticity and co-existing motor disorders and their early musculoskeletal complications. NICE Clinical Guideline.National Institute for Health and Clinical Excellence, Manchester2012
- A summary of spasticity management—a treatment algorithm.Eur J Neurol. 2002; 9: 48-52
Snoek GJ, Kiekens C. Treatment algorithm for spasticity in adults with emphasis on intrathecal baclofen therapy. 47th International Spinal Cord Society (ISCOS) Annual Scientific Meeting; 2008 Sept 1-4; Durban (South Africa).
Brin MF, editor, Spasticity Study Group. Supplement: spasticity: etiology, evaluation, management, and the role of botulinum toxin type A. A training syllabus developed by the Spasticity Study Group. Muscle Nerve 1997;20(Suppl 6):S1–S231.
- Pharmacological interventions for spasticity following spinal cord injury.Cochrane Database Syst Rev. 2000; : CD001131
- Influence of posture and muscle length on stretch reflex activity in poststroke patients with spasticity.Arch Phys Med Rehabil. 2006; 87: 981-988
- The effects of stretching in spasticity: a systematic review.Arch Phys Med Rehabil. 2008; 89: 1395-1406
- Baclofen in the treatment of cerebral palsy.J Child Neurol. 1996; 11: 77-83
- Continuous intrathecal infusion of baclofen in patients with spasticity caused by spinal cord injuries.Neurosurg Rev. 2002; 25: 228-230
- Intrathecal baclofen administration for control of severe spinal spasticity: functional improvement and long-term follow-up.Arch Phys Med Rehabil. 1996; 77: 35-39
- The surgical treatment of spasticity.Muscle Nerve. 1997; 20: S121-S128
- Rating the methodological quality in systematic reviews of studies on measurement properties: a scoring system for the COSMIN checklist.Qual Life Res. 2012; 21: 651-657
- Balance in elderly patients: the “get-up and go” test.Arch Phys Med Rehabil. 1986; 67: 387-389
- Assessing walking ability in subjects with spinal cord injury: validity and reliability of 3 walking tests.Arch Phys Med Rehabil. 2005; 86: 190-196
- ATS statement: guideline for the six-minute walk test.Am J Respir Crit Care Med. 2002; 166: 111-117
- The inter rater reliability of the original and of the modified Ashworth scale for the assessment of spasticity in patients with spinal cord injury.Spinal Cord. 1996; 34: 560-564
- A systematic review of the Tardieu Scale for the measurement of spasticity.Disabil Rehabil. 2006; 28: 899-907
- A physiologically based clinical measure for spastic reflexes in spinal cord injury.Arch Phys Med Rehabil. 2005; 86: 52-59
- Pain: clinical manual for nursing practice.Mosby, St Louis1989
- Advances in functional assessment for medical rehabilitation.Top Geriatr Rehabil. 1986; 1: 59-74
- SCIM—Spinal Cord Independence Measure: a new disability scale for patients with spinal cord lesions.Spinal Cord. 1997; 35: 850-856
- Functional evaluation: the Barthel Index.Md State Med J. 1965; 14: 56-61
- Development and validation of Patient Reported Impact of Spasticity Measure (PRISM).J Rehabil Res Dev. 2007; 44: 363-371
- The Spinal Cord Injury Spasticity Evaluation Tool: development and evaluation.Arch Phys Med Rehabil. 2007; 88: 1185-1192
Article Info
Publication History
Published online: June 06, 2016
Footnotes
Supported by Medtronic, Inc, which provided sponsorship and logistical support in the form of meeting services, project coordination, manuscript preparation, and literature reviews.
Disclosures: P.E. has a financial relationship with Allergan and Ipsen, outside the submitted work. The other authors have nothing to disclose.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
