Spasticity in spinal cord injury

What is spasticity in spinal cord injury?

Spasticity refers to an uncontrollable increase in muscle tone, often accompanied by other symptoms such as exaggerated reflexes, fatigue, paralysis, or slowed movements.

It is caused by damage to the motor pathways in the central nervous system, either in the brain or spinal cord. More than two-thirds of people with a spinal cord injury experience spasticity, but it can also be triggered by other conditions like stroke, cerebral palsy, traumatic brain injury, or multiple sclerosis.

Triggers intensify the symptoms of spasticity. These include, for example:

• pain in the affected area
• distension of the bladder or bowel
• infection
• emotional arousal

The symptoms of motor neuron damage, referred to as plus phenomena, which include spasticity and uncontrollably heightened reflexes, are also collectively known as spastic movement disorder (SMD).

What happens in the body of someone with spinal cord injury?

Acute spinal cord injury, usually triggered by trauma, initially leads to spinal shock. This is a sudden onset of neurological dysfunction that affects all pathways of the spinal cord. This means that below the lesion there is initially flaccid paralysis with loss of reflexes, as well as a loss of pain perception and sensitivity.

These symptoms can subside within a few days and in some cases even disappear completely. However, spinal shock usually transitions into a complete spinal cord injury after about six to eight weeks, where the flaccid paralysis becomes spastic paresis, and hyperreflexia develops with exaggerated reflexes and additional pathological reflexes that are not present in healthy adults.

Severity of spasticity: which degrees are there?

There are different classifications of spasticity. The symptoms can be categorized according to the affected area, for example:

• monospasticity: one limb
• paraspasticity: both legs
• hemispasticity: one side of the body
• tetraspasticity: all extremities, possibly with neck and trunk muscles

Another frequently used classification is the Ashworth scale. This involves the affected muscles being moved passively by the person carrying out the examination and the strength of the resistance is assessed.

• 0: no increased resistance
• 1: slight resistance only at the beginning or end of the movement
• 1+: slight resistance over less than 50% of the range of motion (ROM)
• 2: significant resistance over at least 50% of the ROM
• 3: strong resistance, passive ROM more difficult
• 4: passive ROM restricted

How is spasticity diagnosed in spinal cord injury? 

To diagnose spasticity, a physical examination that tests the muscle tone and assesses the reflex status is sufficient. Since spasticity is often accompanied by additional symptoms and can lead to complications, an assessment should also be conducted through medical history and examination to evaluate issues such as pain, contractures, coordination disorders, and the extent of impairment in daily activities.

Which treatment options are there? 

Different types of therapy are used to treat a spastic movement disorder, usually combining several approaches.

Exoskeletons

Robotic mobile exoskeletons are used as gait trainers. Although there are only a few studies so far, this seems to not only increase exercise effectiveness but also improve symptoms such as spasticity or neuropathic pain in many patients.

Whole-body vibration

A whole-body vibration treatment can reduce the spastically increased muscle tone for several days.

Repetitive Transcranial Magnetic Stimulation (rTMS)

In this procedure, a magnetic field is generated to stimulate certain areas of the brain, which in the case of spasticity are the motor areas. With incomplete spinal cord injury, this appears to have a positive effect on walking ability.

Physical measures

Cold/heat, massages, splinting, taping, shock wave therapy, etc.

Oral medication therapy

In addition to medication treatment for neuropathic pain, there are various antispastic medications. Baclofen and Tizanidine are approved in Germany for the treatment of spasticity in the context of spinal cord injury, and other drugs such as benzodiazepines or dantrolene are used off-label.

Botulinum toxin injections

The toxin from the botulinum bacterium inhibits the transmission of excitation from nerve to muscle cells. An injection into affected muscles can improve spasticity and spasticity-associated pain for several months.

Intrathecal baclofen pump

In this case, the antispastic medication is given directly into the cerebrospinal fluid spaces of the central nervous system using a small implantable pump.

Surgical treatments

If spasticity cannot be controlled by other forms of therapy and is accompanied by significant suffering then surgical interventions, for example by cutting certain nerves or repositioning the attachments of functioning muscles, can be considered.

What is the difference between spasticity and spasms?

Spasms are short, sudden muscle reflexes, which are part of the symptom complex of spasticity.

Spasticity has a tonic component, where movements are inhibited due to a continuously increased muscle tone, and a phasic component, which manifests through involuntary movements. This includes short-term spasms as well as clonus, which are repetitive muscle twitches that can last for several minutes.

Which doctors & clinics specialize in spasticity related to spinal cord injury? 

Spastic paralysis as part of a spinal cord injury is a neurological condition. However, as spinal cord injury often requires treatment by doctors from different specialties, there are clinics that specialize in the treatment of this condition with all its symptoms, including spasticity.

Physiotherapists, psychotherapists and occupational therapists are also involved in rehabilitative treatment.

Anyone in need of a doctor would expect the best possible medical care for themselves. Therefore, patients are looking for the most suitable clinic for their needs. Since this is not an objective decision and a respectable doctor would refrain from claiming to be the best, patients must trust the experience of a doctor.

We can help you find an appropriate expert for your condition. All the doctors and clinics listed have undergone extensive review and have been verified by us for their outstanding expertise in the field of spasticity in spinal cord injury osteoma. They are looking forward to and are ready to address your questions and treatment requests.