Prevalence and Effect of Problematic Spasticity After Traumatic Spinal Cord Injury.

Publication Type
Journal Article
Year of Publication
Holtz, Kaila A; Lipson, Rachel; Noonan, Vanessa K; Kwon, Brian K; Mills, Patricia B
Arch Phys Med Rehabil
Date Published
2017 06
Activities of Daily Living; Adolescent; Adult; Aged; Aged, 80 and over; Disability Evaluation; Female; Humans; Male; Middle Aged; Muscle Spasticity; Prevalence; Prospective Studies; Rehabilitation Centers; Retrospective Studies; Spinal Cord Injuries; Trauma Severity Indices; Young Adult

OBJECTIVE: To evaluate the prevalence and effect of spasticity after traumatic spinal cord injury (SCI).

DESIGN: Prospective cohort study of the Rick Hansen Spinal Cord Injury Registry (RHSCIR) and retrospective review of inpatient medical charts.

SETTING: Quaternary trauma center, rehabilitation center, and community settings.

PARTICIPANTS: Individuals (N=860) with a traumatic SCI between March 1, 2005, and March 31, 2014, prospectively enrolled in the Vancouver site RHSCIR were eligible for inclusion.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Questionnaires (Penn Spasm Frequency Scale, Spinal Cord Injury Health Questionnaire) and antispasticity medication use.

RESULTS: In 465 patients, the prevalence of spasticity at community discharge was 65%, and the prevalence of problematic spasticity (defined as discharged on antispasticity medication) was 35%. Problematic spasticity was associated with cervicothoracic neurologic level and injury severity (P<.001). In community follow-up, the prevalence of patients reporting any spasticity treatment (ie, problematic spasticity) was 35% at 1 year, 41% at 2 years, and 31% at 5 years postinjury. Interference with function caused by spasticity was reported by 27% of patients at 1 year, 25% at 2 years, and 20% at 5 years postinjury. Patients with American Spinal Injury Association Impairment Scale grade C injuries had the highest prevalence of ongoing spasticity treatment and functional limitation.

CONCLUSIONS: Spasticity is a highly prevalent secondary consequence of SCI, particularly in patients with severe motor incomplete cervicothoracic injuries. It is problematic in one third of all patients with SCI up to 5 years postinjury. One in 5 patients will have ongoing functional limitations related to spasticity, highlighting the importance of close community follow-up and the need for further research into spasticity management strategies.