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Spasticity in spinal cord injury: self- and clinically rated intrinsic fluctuations and intervention-induced changes.

Abstract

OBJECTIVES

(1) To determine patterns of intrinsic fluctuations in spasticity, using repeated self-ratings, in subjects with spinal cord injury (SCI); and (2) To determine the relation between self-ratings of spasticity using a visual analogue scale (VAS) and clinical ratings of spasticity using the Modified Ashworth Scale (MAS) before and after spasticity-reducing treatment.

DESIGN

Part I: observational, prospective cross-sectional study; part II: experimental, prospective longitudinal study.

SETTING

Outpatient clinic of the Karolinska Hospital, Stockholm, Sweden.

PATIENTS

Forty-five persons with SCI (39 men, 6 women); mean age at injury, 26 yrs; mean time since injury, 11 yrs.

INTERVENTION

Repetitive passive movements of standardized range of motion in three different body positions, performed by two motorized tables.

MAIN OUTCOME MEASURES

VAS ratings of spasticity, every other hour when awake, and of movement-provoked spasticity, rated before and after each treatment session, and MAS ratings of movement-provoked spasticity, before and after each treatment session.

RESULTS

The spasticity of cervical SCI subjects fluctuated significantly (p < .05) during the day, unlike the spasticity of thoracic SCI subjects. Immediately after intervention with passive movements, spasticity ratings in thoracic motor complete SCI patients decreased by 11 to 14 mm (90%, p < .001) as self-rated on VAS and by 1 to 2 grades (50%, p < .001) as measured with MAS. A 30% (p < .018) decrease in VAS values of intrinsic pattern of spasticity was maintained over time when treatment was given regularly and was maintained for at least 1 week after discontinuation of treatment. VAS ratings correlated significantly with MAS ratings (r = .44 to .62, p < .001).

CONCLUSION

Repetitive passive movement intervention decreased spasticity when performed regularly, as assessed by VAS and MAS ratings. VAS and MAS ratings were significantly correlated. It is recommended that SCI patients repeatedly rate their spasticity to establish a baseline before and to track changes after interventions aimed at reducing spasticity. The time of day when spasticity is measured seems more important in cervically injured individuals, because of their more pronounced intrinsic fluctuations.

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  • Publisher Full Text
  • Authors+Show Affiliations

    Department of Clinical Neuroscience, Occupational Therapy, and Elderly Care Research, Karolinska Institute, Stockholm, Sweden.

    Source

    MeSH

    Adolescent
    Adult
    Cervical Vertebrae
    Circadian Rhythm
    Cross-Sectional Studies
    Female
    Humans
    Male
    Middle Aged
    Muscle Contraction
    Pain Measurement
    Paraparesis, Spastic
    Physical Therapy Modalities
    Prospective Studies
    Spinal Cord Injuries
    Thoracic Vertebrae

    Pub Type(s)

    Comparative Study
    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    10668766

    Citation

    Sköld, C. "Spasticity in Spinal Cord Injury: Self- and Clinically Rated Intrinsic Fluctuations and Intervention-induced Changes." Archives of Physical Medicine and Rehabilitation, vol. 81, no. 2, 2000, pp. 144-9.
    Sköld C. Spasticity in spinal cord injury: self- and clinically rated intrinsic fluctuations and intervention-induced changes. Arch Phys Med Rehabil. 2000;81(2):144-9.
    Sköld, C. (2000). Spasticity in spinal cord injury: self- and clinically rated intrinsic fluctuations and intervention-induced changes. Archives of Physical Medicine and Rehabilitation, 81(2), pp. 144-9.
    Sköld C. Spasticity in Spinal Cord Injury: Self- and Clinically Rated Intrinsic Fluctuations and Intervention-induced Changes. Arch Phys Med Rehabil. 2000;81(2):144-9. PubMed PMID: 10668766.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Spasticity in spinal cord injury: self- and clinically rated intrinsic fluctuations and intervention-induced changes. A1 - Sköld,C, PY - 2000/2/11/pubmed PY - 2000/2/26/medline PY - 2000/2/11/entrez SP - 144 EP - 9 JF - Archives of physical medicine and rehabilitation JO - Arch Phys Med Rehabil VL - 81 IS - 2 N2 - OBJECTIVES: (1) To determine patterns of intrinsic fluctuations in spasticity, using repeated self-ratings, in subjects with spinal cord injury (SCI); and (2) To determine the relation between self-ratings of spasticity using a visual analogue scale (VAS) and clinical ratings of spasticity using the Modified Ashworth Scale (MAS) before and after spasticity-reducing treatment. DESIGN: Part I: observational, prospective cross-sectional study; part II: experimental, prospective longitudinal study. SETTING: Outpatient clinic of the Karolinska Hospital, Stockholm, Sweden. PATIENTS: Forty-five persons with SCI (39 men, 6 women); mean age at injury, 26 yrs; mean time since injury, 11 yrs. INTERVENTION: Repetitive passive movements of standardized range of motion in three different body positions, performed by two motorized tables. MAIN OUTCOME MEASURES: VAS ratings of spasticity, every other hour when awake, and of movement-provoked spasticity, rated before and after each treatment session, and MAS ratings of movement-provoked spasticity, before and after each treatment session. RESULTS: The spasticity of cervical SCI subjects fluctuated significantly (p < .05) during the day, unlike the spasticity of thoracic SCI subjects. Immediately after intervention with passive movements, spasticity ratings in thoracic motor complete SCI patients decreased by 11 to 14 mm (90%, p < .001) as self-rated on VAS and by 1 to 2 grades (50%, p < .001) as measured with MAS. A 30% (p < .018) decrease in VAS values of intrinsic pattern of spasticity was maintained over time when treatment was given regularly and was maintained for at least 1 week after discontinuation of treatment. VAS ratings correlated significantly with MAS ratings (r = .44 to .62, p < .001). CONCLUSION: Repetitive passive movement intervention decreased spasticity when performed regularly, as assessed by VAS and MAS ratings. VAS and MAS ratings were significantly correlated. It is recommended that SCI patients repeatedly rate their spasticity to establish a baseline before and to track changes after interventions aimed at reducing spasticity. The time of day when spasticity is measured seems more important in cervically injured individuals, because of their more pronounced intrinsic fluctuations. SN - 0003-9993 UR - https://www.unboundmedicine.com/medline/citation/10668766/Spasticity_in_spinal_cord_injury:_self__and_clinically_rated_intrinsic_fluctuations_and_intervention_induced_changes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-9993(00)90132-1 DB - PRIME DP - Unbound Medicine ER -