Spasticity in Spinal Cord Injury

A Clinician’s Approach
  • Kurt Fiedler
  • Douglas R. Jeffery
Part of the Current Clinical Neurology book series (CCNEU)


This chapter reviews the current understanding and management of spasticity following spinal-cord injury (SCI). Attempts to formally define the term “spasticity” vary with the physiological prejudices of the definer, but patients and their caregivers alike often lump together the spasms,the variable stiffness of muscles, the consequent further reduction in dexterity, and the associated pain into a single clinical problem for which treatment is demanded. The first section in this chapter presents an approach to the clinical differentiation of the contributing factors; the second section specifically outlines potential anatomical problem areas; and the third section offers a clinician’s approach to sequential intervention.


Spinal Cord Injury Botulinum Toxin Tourette Syndrome Functional Independence Measure Intrathecal Baclofen 
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  1. 1.
    Zankel, H. T., Sutton, B. B., and Burney, T. E. (1954) A paraplegic program under physical medicine and rehabilitation: one year experience. Arch. Phys. Med. 35, 296–302.PubMedGoogle Scholar
  2. 2.
    Young, R. R. (1994) A review. Neurology 44 (Suppl. 9), S12 — S20.PubMedGoogle Scholar
  3. 3.
    Kaplan, L. I., Grynbaum, B. B., Lloyd, K. E., and Rusk, H. A. (1962) Pain and spasticity in patients with spinal cord dysfunction: results of a follow-up study. JAMA 182, 918–925.Google Scholar
  4. 4.
    Maynard, F. M., Karunas, R. S., and Waring, W. P. (1990) Epidemiology of spasticity following traumatic spinal cord injury. Arch. Phys. Med. Rehabil. 71, 566–569.PubMedGoogle Scholar
  5. 5.
    Bicknell, J. M. and Fiedler, K. (1992) Unrecognized incomplete cervical spinal cord injury: review of nine new and 28 previously reported cases. Am. J. Emerg. Med. 10, 336–343.PubMedCrossRefGoogle Scholar
  6. 6.
    Hinderer, S. R. and Gupta, S. (1996) Functional outcome measures to assess interventions for spasticity. Arch. Phys. Med. Rehabil. 77, 1083–1089.PubMedCrossRefGoogle Scholar
  7. 7.
    Forer, S., et al. (1987) Task Force for Development of a Uniform Data System for Medical Rehabilitation. Guide for Use of the Uniform Data Set for Medical Rehabilitation (FIM). Research Foundation SUNY, Buffalo, NY.Google Scholar
  8. 8.
    Catz, A., Tamir, A., et al. (1997) SCIM–Spinal cord independence measure: a new disability scale for patients with spinal cord lesions. Spinal Cord 35, 850–856.PubMedCrossRefGoogle Scholar
  9. 9.
    Brown P. (1994) Pathophysiology of spasticity. J. Neurol. Neurosurg. Psychiatry 57, 773–777.PubMedCrossRefGoogle Scholar
  10. 10.
    Hufschmidt, A. and Mauritz, K-H. (1985) Chronic transformation of muscle in spasticity: a peripheral contribution to increased tone. J. Neurol. Neurosurg. Psychiatry 48, 676–685.PubMedCrossRefGoogle Scholar
  11. 11.
    Walsh, E. G. (1993) A review of some measurements of muscle wasting, tone and clonus in paraplegia. Paraplegia 31, 75–81.PubMedCrossRefGoogle Scholar
  12. 12.
    Dietz, V., Wirz, M., Curt, A., and Colombo, G. (1998) Locomotor pattern in paraplegic patients: training effects and recovery of spinal cord function. Spinal Cord 36, 380–390.PubMedCrossRefGoogle Scholar
  13. 13.
    Hagbarth, K. E. (1994) Evaluation of and methods to change muscle tone. Scand. J. Rehabil. Med. Suppl. 30, 19–32.PubMedGoogle Scholar
  14. 14.
    Simons D. G. and Mense, S. (1998) Understanding and measurement of muscle tone as related to clinical muscle pain. Pain 75, 1–17.PubMedCrossRefGoogle Scholar
  15. 15.
    O’Dwyer, N. J., Ada, L., and Neilson, P. D. (1996) Spasticity and muscle contracture following stroke. Brain 119, 1737–1749.Google Scholar
  16. 16.
    Michaelis, L. S. (1976) Spasticity in spinal cord injuries, in Injuries of the Spine and Spinal Cord, Part II. Handbook of Clinical Neurology, vol 26. ( Vinken, P. J., Bruyn, G. W., and Braakman, R., eds.), American Elsevier, New York, pp. 477–487.Google Scholar
  17. 17.
    Little, J. W., Ditunno, J. F., Stiens, S., and Harris, R. M. (1999) Incomplete spinal cord injury: neuronal mechanisms of motor recovery and hyperreflexia. Arch. Phys. Med. Rehabil. 80, 587–599.PubMedCrossRefGoogle Scholar
  18. 18.
    Ragnarsson, K. T. (1992) Functional electrical stimulation and suppression of spasticity following spinal cord injury. Bull. NY Acad. Med. 68, 351–364.Google Scholar
  19. 19.
    Bok, Y. L., Karmakar, M. G., et al. (1995) Autonomic dysreflexia revisited. J. Spinal Cord Med. 18, 75–87.Google Scholar
  20. 20.
    Frank, R. G., Umlauf, R. L., Wonderlich, S. A., et al. (1987) Differences in coping styles among persons with spinal cord injury: a cluster analytic approach. J. Consult. Clin. Psychol. 55, 727–731.PubMedCrossRefGoogle Scholar
  21. 21.
    Guttmann, L. (1973) Spinal Cord Injuries: Comprehensive Management and Research. Blackwell, Oxford, UK, pg. 21.Google Scholar
  22. 22.
    Leckman, J. F., Pauls, D. L., Peterson, B. S., et al. (1992) Pathogenesis of Tourette syndrome: clues from the clinical phenotype and natural history. Adv. Neurol. 58, 15–24.PubMedGoogle Scholar
  23. 23.
    Daylan, M., Sherman, A., and Cardenas, D. D. (1998) Factors associated with contractures in acute spinal cord injury. Spinal Cord 36, 405–408.CrossRefGoogle Scholar
  24. 24.
    Massey, J. A. (1988) Urodynamic and neurophysiological assessment of the neuropathie bladder, in Spinal Cord Dysfunction: Assessment ( Illis, L.S., ed.), Oxford University Press, OxfordGoogle Scholar
  25. 25.
    Zorowitz, R. D., Hughes, M. B., et al. (1996) Shoulder subluxation and pain after stroke: correlation or coincidence? Am. J. Occup. Ther. 50, 194–201.PubMedCrossRefGoogle Scholar
  26. 26.
    McPherson, J. J., Beck, A. H., and Franszcak, N. (1985) Dynamic splint to reduce the passive component of hypertonicity. Arch. Phys. Med. Rehabil. 66, 249–252.PubMedCrossRefGoogle Scholar
  27. 27.
    Dimitrijevic, Faganel, J., and Young, R. R. (1981) Underlying mechanisms of the effects of spinal cord stimulation in motor disorders: a review of the discussion. Appl. Neurophysiol. 44, 133–140.Google Scholar
  28. 28.
    Barbeau, H. and Fung, J. (1992) New experimental approaches in the treatment of spastic gait disorders, in Movement Disorders in Children (Forssberg, H. and Hirschfeld, H., eds.) Med. Sports Science Karger, Basel.Google Scholar
  29. 29.
    Rushton, D. N., Barr, F. M. D., Donaldson, N de N, et al. (1998) Selecting candidates for a lower limb stimulator implant programme: a patient-centered method. Spinal Cord 36, 303–309.PubMedCrossRefGoogle Scholar
  30. 30.
    Subramanian, N., Vaughan, C. L., Peter, J. C., and Arens, L. J. (1998) Gait before and ten years after rhizotomy in children with cerebral palsy spasticity. J. Neurosurg. 88, 1014–1019.PubMedCrossRefGoogle Scholar
  31. 31.
    Gerszten, P. C., Albright, L., and Johnstone, G. F. (1998) Intrathecal baclofen infusion and subsequent orthopedic surgery in patients with spastic cerebral palsy. J. Neurosurg. 88, 1009.PubMedCrossRefGoogle Scholar
  32. 32.
    Nance, P. W., Bugaresti, J., Shellenberger, K., Sheramata, W., Martinez-Arizala, A., and the North American Tizanidine Study Group. (1994) Efficacy and safety of tizanidine in the treatment of spasticity in patients with spinal cord injury. Neurology 44 (Suppl. 9), S44 - S52.Google Scholar
  33. 33.
    Davidoff, R. A. (1985) Antispasticity drugs: mechanism of action. Ann. Neurol. 17, 107–116.PubMedCrossRefGoogle Scholar
  34. 34.
    Pinder, R. M., Brogden, R. J. N., Speight, T. M., and Avery, G. S. (1997) Dantrolene sodium: a review of its pharmacological properties and therapeutic efficacy in spasticity. Drugs 13, 3–23.CrossRefGoogle Scholar
  35. 35.
    Gruenthal, M., Mueller, M., Olson, W. L., Priebe, M. M., Sherwood, A. M., and Olson, W. H. (1997) Gabapentin for the treatment of spasticity in patients with spinal cord injury. Spinal Cord 35, 868–869.CrossRefGoogle Scholar
  36. 36.
    Priebe, M. M. Sherwood, A. M., Graves, D. E., Mueller, M., and Olson, W. H. (1997) Effectiveness of gabapentin in controlling spasticity: a quantitative study. Spinal Cord 35 171–175.Google Scholar
  37. 37.
    Barbeau, H. Richards, C. L., and Bedard, B. J. (1982) Action of cyproheptadine in spastic paraparetic patients. J. Neurol. Neurosurg. Psychiatry 45 923.Google Scholar
  38. 38.
    Nance, P. (1994) A comparison of clonidine, cyroheptadine and baclofen in spastic spinal cord injured patients. J. Am. Paraplegia Soc. 17, 151–157.Google Scholar
  39. 39.
    Weingarden, S. I. and Belen, J. G. (1992) Clonidine transdermal system for treatment of spasticity in spinal cord injury. Arch. Phys. Med. Rehabil. 73, 876–877.Google Scholar
  40. 40.
    Erickson, D. L., Blacklock, J. B., Michaelson, M., Sperling, K. B., and Lo, J. N. (1985) Control of spasticity by implantable continuous flow morphine pump. Neurology 16, 215–217.Google Scholar
  41. 41.
    Donovan, W. H., Carter, R. E., Rossi, C. D., and Wilkerson, M. A. (1988) Cloni-dine effect on spasticity: a clinical trial. Arch. Phys. Med. Rehabil. 69, 193–194.PubMedGoogle Scholar
  42. 42.
    Meinck, H. M., Schönle, P. W., and Conrad, B. (1989) Effect of cannabinoids on spasticity and ataxia in multiple sclerosis. J. Neurol. 236, 120–122.PubMedCrossRefGoogle Scholar
  43. 43.
    Mueller, M. E., Gruenthal, M., and Olson, W. L. (1997) Gabapentin for relief of upper motor neuron symptoms in multiple sclerosis. Arch. Phys. Med. Rehabil. 78, 521–524.PubMedCrossRefGoogle Scholar
  44. 44.
    Coffey, R. J., Cahill, D., Steers, W., and Park, T. S. (1993) Intrathecal baclofen for intractable spasticity of spinal origin: results of long-term multicenter study. J. Neurosurg. 78, 226–232.PubMedCrossRefGoogle Scholar
  45. 45.
    Nance, P., Schryvers, O., Schmidt, B., Dubo, H., Loveridge, B., and Fewer, D. (1995) Intrathecal baclofen therapy for adults with spinal spasticity: therapeutic efficacy and effect on hospital admissions. Can. J. Neurol. Sci. 22, 22–29.PubMedGoogle Scholar
  46. 46.
    Lazorthes, Y., Sallerin-Caute, B., Verdie, J., Bastide, R., and Carillo, J. (1990) Chronic intrathecal baclofen administration for control of severe spasticity. J. Neurosurg. 72, 393–402.PubMedCrossRefGoogle Scholar
  47. 47.
    Rifici, C., Kofler, M., Kronenberg, M., Kofler, A., Bramanti, P., and Saltuari, L. (1994) Intrathecal baclofen application in patients with supraspinal spasticity secondary to severe traumatic brain injury. Funct. Neurol. 9, 29–34.PubMedGoogle Scholar
  48. 48.
    Penn, R. D., Savoy, S. M., Corcos, D., Latash, M., Gottlieb, G., Parke, B., and Kroin, J. S. (1989) Intrathecal baclofen for severe spinal spasticity. N. Engl. J. Med. 320, 517–521.CrossRefGoogle Scholar
  49. 49.
    Latash, M. L., Penn, R. D„ Corcos, D. M., and Gottlieb, G. L. (1990) Effects of intrathecal baclofen on voluntary motor control in spastic paresis. J. Neurosurg. 72, 388–392.Google Scholar
  50. 50.
    Loubser, P. G., Narayan, R. K., Sandin, K. J., Donovan, W. H., and Russell, K. D. (1991) Continuous infusion of intrathecal baclofen: long-term effects on spasticity in spinal cord injury. Paraplegia 29, 48–52.PubMedCrossRefGoogle Scholar
  51. 51.
    Ochs, G., Struppler, A., Meyerson, B. A., Linderoth, B., and Gybels, J. (1989) Intrathecal baclofen for long-term treatment of spasticity; a multicentre study. J. Neurol. Neurosurg. Psychiatry 52, 933–939.PubMedCrossRefGoogle Scholar
  52. 52.
    Meythaler, J. M., DeVivo, M. J., and Hadley, M. (1996) Prospective study on the use of bolus intrathecal baclofen for spastic hypertonia due to acquired brain injury. Arch. Phys. Med. Rehabil. 77, 461–466.PubMedCrossRefGoogle Scholar
  53. 53.
    Reeves, R. K., Stolp-Smith, K. A., and Christopherson, M. W. (1998) Hyperthermia, rhabdomyolysis, and disseminated intravascular coagulation associated with baclofen pump catheter failure. Arch. Phys. Med. Rehabil. 79, 353–356.PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media New York 2002

Authors and Affiliations

  • Kurt Fiedler
  • Douglas R. Jeffery

There are no affiliations available

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