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Spasticity following spinal cord injury
Clinical Orthopaedics and Related Research
|October 1, 1975
Summary
Spasticity, a condition affecting spinal cord injury patients, involves hyper-excitable reflexes impacting motor function and autonomic systems. Early recognition and treatment of underlying causes are key to managing this condition.
Area of Science:
- Neuroscience
- Rehabilitation Medicine
- Spinal Cord Injury Research
Background:
- Spasticity is a common complication following spinal cord injury (SCI), characterized by hyper-excitable reflex arcs below the injury level.
- It affects not only motor function but also autonomic systems, including bladder, bowel, blood pressure, and erection reflexes.
- Spasticity typically emerges 1-2 months post-injury, reaching a plateau within 3-4 months, and can be exacerbated by underlying conditions.
Purpose of the Study:
- To elucidate the neurophysiological mechanisms underlying spasticity after SCI.
- To emphasize the importance of recognizing spasticity as a potential indicator of underlying pain or pathology.
- To review and recommend effective management and treatment strategies for spasticity in SCI patients.
Main Methods:
- Review of neurophysiological mechanisms involving alpha and gamma reflex systems and interneuronal excitability.
- Analysis of spasticity as a pain substitute, triggered by conditions like infections or pressure ulcers.
- Evaluation of various treatment modalities, including medication, nerve blocks, surgical interventions, and preventative measures.
Main Results:
- Neurophysiological evidence points to increased activity in alpha and gamma reflex systems and enhanced central excitability.
- Excessive spasticity can serve as a non-specific sign of underlying painful conditions in SCI patients.
- Preventative strategies, including education and health maintenance, are crucial for managing spasticity.
Conclusions:
- Spasticity is not a normal consequence of SCI and necessitates investigation into its underlying cause.
- While medications (e.g., Valium, Dantrolene) and nerve blocks can manage symptoms, addressing the root cause is paramount.
- Less destructive surgical options like selective longitudinal myelotomy are preferred over ablative procedures; tendonotomies may be needed for chronic contractures.