Promoting Best Practice in the Management of Spasticity Following Spinal Cord Injury

Executive Summary:

Every year in Australia, approximately 350-400 new cases of traumatic spinal cord injury (SCI) occur, adding to the 12,000 individuals currently living with a SCI. Following a SCI, damage to the nerve pathways which control muscle movement results in increased muscle tone and stiffness, and consequently spasticity. Spasticity can be painful and cause major discomfort, which impedes activities of daily living. It can cause serious, permanent effects if it is not treated or controlled such as fixed joints (contractures), as well as contribute to injuries that negatively impact on the person’s life.

Management of spasticity following SCI typically follows an appropriate assessment of symptoms, and an approach to treatment of symptoms with one or multiple types of non- pharmacological, pharmacological and surgical interventions. Currently, the most commonly used spasticity assessment tools are the Ashworth Scale, Modified Ashworth Scale, and the Spasm Frequency Scale. These tools only measure certain aspects of spasticity and hence they do not reflect the overall impact of spasticity on an individual. In terms of treatment interventions, there is only moderate level evidence for the effectiveness of non- pharmacological approaches including transcutaneous electrical nerve stimulation (TENS), direct electrical muscle stimulation, functional electrical stimulation (FES)-assisted cycling, hydrotherapy and whole body vibration. Similarly, there is only moderate level evidence for the effectiveness of the oral pharmacological treatments tizanidine and baclofen, and for the surgical dorsal T-myelotomy technique. In addition to limited evidence of effectiveness, pharmacological and surgical approaches can produce some unwanted, serious adverse effects that impact on the quality of life of a person with SCI.

An NTRI Forum was conducted to identify best practice for optimal management (assessment and treatment) of spasticity in people with spinal cord injury, in particular in the community setting.

Date: July 2015

Management-of-Spasticity-Following-Spinal-Cord-Injury  BD-Spasticity-Following-Spinal-Cord-Injury

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