Study Finds that Stiffness, Ineffectiveness of Medication are Challenges for People with Spinal Cord Injury Who Experience Spasticity

Many people with spinal cord injury (SCI) report that spasticity – specifically stiffness – has a significant negative impact on daily activities and quality of life, according to a recent study by the spinal cord injury research team at Shepherd Center.

The study, published in the January 2018 issue of Spinal Cord (Nature publications), explores which specific characteristics of spasticity – for example, muscle spasms, jerking muscles (clonus) or stiffness – are most troublesome for people with SCI. Ninety-five percent of respondents reported having at least one spasm each day. Of these, 44 percent had 10 or more spasms a day. While conventional wisdom has pointed to spasms as a main spasticity-related challenge in people with SCI, this study suggests that stiffness may be the more troublesome issue.

“Spasticity is a highly common experience after SCI,” says Edelle Field-Fote, PT, PhD, director of spinal cord injury research and the Hulse Spinal Cord Injury Laboratory at Shepherd Center. “What was particularly striking is that stiffness appears to be the most problematic aspect of spasticity – over and above muscle spasms or jerking muscle movements, which are what we typically think of as spasticity.”

Stiffness was also found to have the greatest negative impact on daily activities and patients’ overall wellbeing.

“It can keep someone from being able to use the remaining muscle power they might have,” Dr. Field-Fote explains. “While they may have some muscle function, if on top of being weak they are also stiff, it really limits their ability to function. Even rolling over in bed is very difficult.”

To conduct the study, researchers at Shepherd Center developed and fielded a comprehensive survey of people with SCI. The study involved 145 people with SCI – the majority of whom were more than two years post-injury. They completed a 75-item questionnaire, which included questions from a validated tool called the Patient Reported Impact of Spasticity Measure (PRISM). They also answered questions derived from neurophysiological research that were intended to give a more complete picture of when and how spasticity happens, as well as how it interferes with certain activities such as exercise, feeding oneself, hygiene and getting dressed. Researchers say it’s the largest survey to date to assess the characteristics of spasticity that most affect daily life.

Another key finding is that among those who take medication for spasticity, more than half – 58 percent – reported they don’t get relief from them. Not only does this underscore the need for more non-pharmacologic ways of managing spasticity, it may also suggest that current medications have limited effects on stiffness.

“People experience spasticity in very different ways, so there can’t be a one-size-fits-all approach to how it is treated,” Dr. Field-Fote says.

Shepherd Center researchers are hopeful that these findings will encourage clinicians to adopt a broader understanding of how spasticity affects people with SCI, including applying a more expansive definition of spasticity proposed by the European SPASM Consortium, which includes both the intermittent muscle activity associated with spasms, as well as the more sustained muscle activity that gives rise to stiffness.

Researchers stress that larger studies are needed to more fully understand the dynamic nature of spasticity in people with SCI so that clinicians can help patients manage their condition more effectively.

For more information about research at Shepherd Center, visit shepherd.org/research.

Written by Amanda Crowe, MA, MPH