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OTHER COMPLICATIONS OF SPINAL CORD INJURY: SPASTICITY

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     Spasticity is common in varying degrees after spinal cord injury. Spasticity is a non-specific symptom, which may occur in many problems associated with spinal cord injury.

     Spasticity is the involuntary movement (jerking) of muscles, which occurs because messages can travel from parts of your body to the spinal cord and cause reflex activity (muscle movement). This is possible because the spinal cord has certain normal automatic functions, which are under the influence of the brain. These functions include muscle tone and reflexes. Most spinal cord injured persons have a healthy, intact spinal cord below the immediate area of their injury, and thus these automatic activities can continue to exist. However, they are no longer under the regulating influence of the brain and are thus exaggerated. This is called spasticity.

     Any sensory stimulus below the level of injury can cause spasticity, for example, a change in body position (i.e., movement of an extremity), bladder irritation, pressure sores, fractured bones or a bowel program.

     Sometimes, minor degrees of spasticity may be helpful to you. Due to the muscle movement, your circulation is improved and the movement also helps to maintain the shape and bulk of your muscles. However, if it is severe, spasticity can interfere with functional activities such as transfers, weight shifts, gait training, etc.

     Some stimuli can cause a change in your spasticity. Anything that would ordinarily be uncomfortable or painful can cause an increase in your spasticity. If you experience a major increase in spasticity, possible causes are:

  • Skin problems - a skin sore or ingrown toenail
  • Bladder problems - high residuals, infection or bladder stones
  • Bowel problems - constipation, impactions or hemorrhoids
  • Medical problems - viral syndrome (infection, influenza, intestinal flu), heterotopic ossification or a spinal cyst.

     Although a change in the pattern of your spasticity does not always indicate another problem, it is wise to check all possibilities.

     If your spasticity is severe and interferes with function, there are several medications that may be of help -- Lioresal (Baclofen), Tizanidine, Dantrolene, Clonidine, Neurontin and Diazepam. A surgical procedure called a radiofrequency rhizotomy is sometimes indicated in the treatment of severe spasticity. If you have increased spasticity, which persists, consult your physician.

     Other interventions to help reduce or control spasms include injections of Botulinum Toxin A (Botox) or phenol directly into the muscles of concern. Injection therapy usually lasts 3-4 months. Surgical interventions include the insertion of an Intrathecal Baclofen Pump. A Baclofen pump trial is conducted first to make sure there is an adequate response to the intrathecal baclofen. Once it is determined that a person responds to the intrathecal baclofen therapy, surgery is scheduled. The pump must be refilled every three months but is dependent upon the amount of drug needed by each person.

     Other ways to decrease spasticity includes self ranging or range of motion exercises, aquatic or pool therapy and standing activities such as in a standing frame. These exercise programs should be done on a routine basis as part of your overall health and wellness maintenance.

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