Shirley Ryan AbilityLab, Chicago, Illinois.
Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois.
J Neurophysiol. 2022 Sep 1;128(3):470-479. doi: 10.1152/jn.00126.2022. Epub 2022 May 4.
Spasticity is one of the most common symptoms manifested following spinal cord injury (SCI). The aim of this study was to assess spasticity in individuals with subacute and chronic SCI with different injury severity, standardizing the time and assessments of spasticity. We tested 110 individuals with SCI classified by the American Spinal Injury Association Impairment Scale (AIS) as either motor complete (AIS A and B; subacute, = 25; chronic, = 33) or motor incomplete (AIS C and D; subacute, = 23; chronic, = 29) at a similar time after injury (subacute, ∼1 mo after injury during inpatient rehabilitation and chronic, ≥1 yr after injury) using clinical (modified Ashworth scale) and kinematic (pendulum test) outcomes to assess spasticity in the quadriceps femoris muscle. Using both methodologies, we found that among individuals with subacute motor complete injuries, only a minority showed spasticity, whereas the majority exhibited no spasticity. This finding stands in contrast to individuals with subacute motor incomplete injury, where both methodologies revealed that a majority exhibited spasticity, whereas a minority exhibited no spasticity. In chronic injuries, most individuals showed spasticity regardless of injury severity. Notably, when spasticity was present, its magnitude was similar across injury severity in both subacute and chronic injuries. Our results suggest that the prevalence, not the magnitude, of spasticity differs between individuals with motor complete and incomplete SCI in the subacute and chronic stages of the injury. We thus argue that considering the "presence of spasticity" might help the stratification of participants with motor complete injuries for clinical trials. The prevalence of spasticity in humans with SCI remains poorly understood. Using kinematic and clinical outcomes, we examined spasticity in individuals with subacute and chronic injuries of different severity. We found that spasticity in the quadriceps femoris muscle was more prevalent among individuals with subacute motor incomplete than in those with motor complete injuries. However, in a different group of individuals with chronic injuries, no differences were found in the prevalence of spasticity across injury severity.
痉挛是脊髓损伤（SCI）后最常见的症状之一。本研究旨在评估不同损伤严重程度的亚急性和慢性 SCI 患者的痉挛程度，并对痉挛进行标准化的时间和评估。我们测试了 110 名 SCI 患者，根据美国脊髓损伤协会损伤量表（AIS）分为运动完全性损伤（AIS A 和 B；亚急性，n=25；慢性，n=33）或运动不完全性损伤（AIS C 和 D；亚急性，n=23；慢性，n=29），在损伤后相似的时间（亚急性，在住院康复期间受伤后约 1 个月；慢性，受伤后≥1 年），使用临床（改良 Ashworth 量表）和运动学（摆锤试验）评估股四头肌的痉挛。使用这两种方法，我们发现，在亚急性运动完全性损伤的患者中，只有少数患者表现出痉挛，而大多数患者则没有痉挛。这一发现与亚急性运动不完全性损伤的患者形成鲜明对比，这两种方法都表明，大多数患者存在痉挛，而少数患者不存在痉挛。在慢性损伤中，大多数患者都有痉挛，无论损伤严重程度如何。值得注意的是，当存在痉挛时，其严重程度在亚急性和慢性损伤中，无论损伤严重程度如何，都相似。我们的结果表明，在亚急性和慢性损伤阶段，运动完全性和不完全性 SCI 患者的痉挛发生率而非严重程度不同。因此，我们认为考虑“痉挛的存在”可能有助于对运动完全性损伤患者进行临床试验的分层。人类 SCI 患者的痉挛发生率仍知之甚少。我们使用运动学和临床结果，检查了不同严重程度的亚急性和慢性损伤患者的痉挛情况。我们发现，亚急性运动不完全性损伤患者的股四头肌痉挛比运动完全性损伤患者更为常见。然而，在另一组慢性损伤患者中，损伤严重程度之间的痉挛发生率没有差异。
