Impact of specific symptoms of spasticity on voluntary lower limb muscle function, gait and daily activities during subacute and chronic spinal cord injury

Article type: Research Article

Authors: Bravo-Esteban, E.^{a; b} | Taylor, J.^a | Abián-Vicén, J.^c | Albu, S.^a | Simón-Martínez, C.^a | Torricelli, D.^b | Gómez-Soriano, J.^{a; d; *}

Affiliations: [a] Sensorimotor Function Group, Hospital Nacional de Parapléjicos, Toledo, Spain | [b] IAI, Consejo Superior de Investigación Cientifíca (CSIC), Arganda del Rey, Spain | [c] Department of Physical Therapy, Universidad Camilo José Cela, Madrid, Spain | [d] Escuela de Enfermería y Fisioterapia, Universidad de Castilla LaMancha, Toledo, Spain

Correspondence: [*] Address for correspondence: Julio Gómez-Soriano, E.U.E. Fisioterapia, Universidad de Castilla la Mancha, Toledo, Spain. Tel.: +34 925 268 800; Ext: 5845; Fax: +34 902204130; E-mail: julio.soriano@uclm.es

Abstract: Background:Although the spasticity syndrome is an important sensorimotor disorder, the impact of grade of lower limb muscle hypertonia, spasm and clonus activity on voluntary muscle function, gait and daily activities has not been systematically analysed during subacute and chronic spinal cord injury (SCI). Objective:To determine the prevalence of spasticity signs and symptoms during SCI, and to assess their impact on motor function and activities. Methods:A descriptive transverse study of sixty-six subjects with SCI was performed by assessing injury characteristics, spasticity (modified Ashworth scale, Penn scale, SCATS scale) and motor function (lower limb manual muscle scores, WISCI II, spinal cord injury spasticity evaluation tool). Results:Most subjects with the spasticity syndrome presented lower limb hypertonia and spasms during both subacute and chronic SCI, interfering with daily life activities. Subjects with incomplete SCI and hypertonia revealed a loss of voluntary flexor muscle activity, while extensors spasms contributed strongly to loss of gait function. The Penn spasms scale no correlated with muscle function or gait. Conclusions:Specific diagnosis of spasm activity during subacute SCI, and its impact on lower limb voluntary muscle activity, gait function and daily activities, is required to develop a more effective neurorehabilitation treatment strategy.

Keywords: Spinal cord injury, spasticity syndrome, hypertonia, spasms, flexor and extensor muscle, subacute and chronic spinal cord injury, spasticity severity, AIS, manual muscle score, WISCI II, SCI-SET, SCATS, penn scale, modified ashworth scale

DOI: 10.3233/NRE-131000

Journal: NeuroRehabilitation, vol. 33, no. 4, pp. 531-543, 2013