Spasticity : an elusive problem after spinal cord injury

<p>The aim of this thesis was to characterize spasticity in individuals and in a near total prevalence population with traumatic spinal cord (SCI) injury by assessment of: Article I) Relation between Self-reporting of symptoms, neurologic examination (ASIA), physical therapy examination, ROM and complications; Article II) Repeated self-rating (VAS), and the relation between movement- provoked MAS rating and self-rating after a repetitive passive movement intervention; Article III) Correlation between movement-provoked MAS rating during simultaneous recording of EMG thigh muscle activity; Article IV) Correlation between Isokinetic movement-provoked resistive torque measurements during recording of EMG thigh muscle activity; and Article V) FES induced changes in body composition evaluated by CT and in spasticity by using the methods from articles II-IV.</p><p>Article I comprised the near-total prevalence population (n=354) of individuals with traumatic SCI in Stockholm. Article II comprised 45 individuals with various levels and degrees of injury. Articles III- V comprised 15 male individuals with a cervical motor complete SCI. Problematic spasticity was significantly more common in individuals with a cervical incomplete (ASIA B-D) injury. Reports of beneficial effects of spasticity were significantly less common in females and in subgroups with duration of injury less than 4 years. Spasticity was elicitable by movement provocation in only 60% of the individuals reporting spasticity. Spasticity of SCI subjects with a cervical injury fluctuated significantly (p<0.05) during time of the day, unlike spasticity of SCI subjects with thoracic injury. Immediately after intervention with passive movements, spasticity ratings (VAS) in SCI patients with a thoracic motor complete injury decreased by 11-14 mm (90%, p<0.001) as self-rated on VAS and by 1-2 grades (50%, p<0.001) as measured with MAS.</p><p>Spasticity was provoked in 50% of the subjects. while correlations between MAS grades and EMG values were calculated both including and excluding the MAS 0-grade ratings. 80% of spasticity MAS ratings (0-grades included) correlated significantly (p<0.05) with simultaneous EMG values. The flexion movement correlated significantly (p<0.05) irrespective of side and regardless whether O-grades were included or excluded as opposed to extension movement. Significantly higher isokinetic resistance (p=0.049) was provoked for extension movement compared to that of flexion. Contrary, the maximum EMG thigh muscle activity was significantly higher (p=0.009) during flexion provocation compared to that during extension. No change in FES induced spasticity (evaluated as in studies II-IV) was seen in the training group when compared with the control group. The training group increased their leg muscle volume by an average of 1300 cm3 (p<0.001) as compared to the control group who experienced no change. No significant changes were found in the subject's lower extremity or abdomen with regard to subcutaneous and visceral adipose tissue (AT).</p><p>This thesis has highlighted in subjective and objective data sets of spasticity in SCI man, the elusive nature of this prevalent symptom. Careful comparisons of self-assessments, clinical assessments, and in occasional systematic studies objective measures are recommended.</p><h3>List of scientific papers</h3><p>I. Sköld C, Levi R, Seiger Å (1999). "Spasticity after traumatic spinal cord injury: nature, severity, and location. " Arch Phys Med Rehabil 80(12): 1548-1557 <br><a href="https://pubmed.ncbi.nlm.nih.gov/20064675">https://pubmed.ncbi.nlm.nih.gov/20064675</a><br><br></p><p>II. Sköld C (2000). "Spasticity in spinal cord injury: self- and clinically rated intrinsic fluctuations and intervention-induced changes. " Arch Phys Med Rehabil 81(2): 144-149 <br><a href="https://pubmed.ncbi.nlm.nih.gov/20132200">https://pubmed.ncbi.nlm.nih.gov/20132200</a><br><br></p><p>III. Sköld C, Harms-Ringdahl K, Hultling C, Levi R, Seiger Å. (1998). "Simultaneous Ashworth measurements and electromyographic recordings in tetraplegic patients." Arch Phys Med Rehabil 79(8): 959-965 <br><a href="https://pubmed.ncbi.nlm.nih.gov/98373944">https://pubmed.ncbi.nlm.nih.gov/98373944</a><br><br></p><p>IV. Sköld C, Harms-Ringdahl K, Seiger Å (1970). "Movementprovoked muscle torque and electromyographic activity in spastic motor complete SCI individuals." (Submitted)</p><p>V. Sköld C, Lönn L, Harms-Ringdahl K, Hultling C, Levi R, Nash MS, Seiger Å (1970). "Effects of FES training for 6 months on body composition and spasticity in motor complete tetraplegic SCI individuals." (Submitted)</p>