Presentation on theme: "Spasticity after spinal cord injury"— Presentation transcript:
1Spasticity after spinal cord injury Jens Bo NielsenDepartment of Physical Exercise and Sport Science&Department of Neuroscience and PharmacologyPanumKøbenhavns Universitet
2Center for Research in Spasticity and Neurorehabilitation Purpose: Coordination of research activities in danish laboratories devoted to research in Spasticity and NeurorehabilitationBy:1) Facilitate transfer of knowledge from basic neurobiology to clinic2) Facilitate development of new evaluation and rehabilitation techniques with a neuroscientific basisCenter for Research in Spasticity and NeurorehabilitationRigshospitaletPanumHans HultbornKurt JørgensenJens Bo NielsenJørgen E. NielsenNicolas PetersenFin Biering-SørensenClarissa CroneChristian KrarupMads RavnborgHvidovre hospitalTerry JerniganSøren Anker PedersenEgill RostrupStig Sonne-HolmJesper BenckeThomas SinkjærJørgen Feldbæk Nielsen2
3Spasticity – short history 1841 – Marshall Hall: Decapitated frogs. Automatic movements in paretic limbs – called reflexes (introduced by Willis). Tone: Certain degree of firmness. Tone caused by reflexes1863 – Sechenev: release of reflex function from cerebral inhibition1880: Brissaud differentiates reflex mediated stiffness and contracture with the use of ischemia (blocks reflex)1885: Gowers argues that stretch reflex and tone are related1890: Haidenhain concludes that tone is a reflex which depends on resistance: Sherrington describes reflexes and points out that muscle tone is complex and should be carefully described when mentioned.
4Definition of spasticity Spasticity is a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes (’muscle tone’) with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex, as one component of the upper motor neuron syndrome.Lance, Spasticity: Disordered Motor Control 1980
5But in the clinic ”spasticity” is used more broadly: Increased muscle toneMultiple sclerosisStrokeSpinal cord injuryAmyotrophic lateral sclerosisTraumatic brain injuryCerebral palsyTumorsHereditary spastic paraparesis(Neurolatyrism)(hyperekplexia (startle disease)?)Hyperexcitable tendon jerks(stretch reflexes)SpasmsSpastic gaitBabinskiIncreased flexor reflexesand contractures
6Different pathophysiological mechanisms are involved Lance´s definitionVelocity dependent resistance to stretch. Increased stretch reflexesSpasms – sustained activity after input. Role of flexor reflexes, role of Mn properties?Spontaneous muscle activity at ´rest´. = increased muscle tone at rest. Lesion of basal ganglia?Contractures. Alteration of passive muscle propertiesSpastic Gait ??
7Does lesion of the corticospinal tract lead to spasticity? Evidence from monkeysNO: Towers 1940NO: Lawrence & Kuypers. The functional organization of the motor system in the monkey. I. The effects of bilateral pyramidal lesions. Brain Mar;91(1):1-14.Evidence from humanNO: Sherman et al. J Neurol Sci Apr 15;175(2):NO: Nathan PW Effects on movement of surgical incisions into the human spinal cord. Brain Apr;117 ( Pt 2):Yes: Paulson et al. Arch Neurol Jan;43(1):93-5.
8Spasticity is not seen immediately after lesion but develops over several months From Ashby 1973
10Control of reciprocal inhibition in healthy human subjects
11Reciprocal inhibition in patients with spasticity Crone C, Nielsen J, Petersen N, Ballegaard M & Hultborn H. (1994). Brain 117,Crone C, Johnsen LL & Nielsen J (2000). Clinical neurophysiology suppl 53,Morita H, Crone C, Christenhuis D, Petersen NT & Nielsen JB. (2001). Brain. 124(Pt 4),Crone C, Johnsen LL, Biering-Sørensen F & Nielsen JB (2003). Appearance of reciprocal facilitation in patients with spasticity. Brain, 126(Pt 2):
12Stretch reflexes are not increased in the active spastic muscle Therefore caution when using antispastic medication:Dietz & Sinkjær Lancet Neurol Aug;6(8):
13SInkjær et al Clin Neurophysiol. 1999 May;110(5):951-9. NBDecreased contribution from afferent feedback to the soleus muscle during walking in patients with spastic stroke. Mazzaro et al. J Stroke Cerebrovasc Dis Jul-Aug;16(4):135-44
14Reduced reflex modulation during bicycling in stroke NBSchindler et al. 2007
15Reciprocal inhibition is increased following explosive strength training. Increased ability of producing force quickly.Geertsen et al.; indsendt til J Appl Physiol15
16How to evaluate spasticity? Ashworth scale has generally been found to be reliable for the upper arm, but NOT for the lower limb(Brashear et al. Arch Phys Med Rehabil Oct;83(10): Blackburn et al. Phys Ther Jan;82(1): Gregson et al. Arch Phys Med Rehabil Sep;80(9): )
17Biomechanical evaluation of spasticity Jakob LorentzenHvidovre hosp.
18Larger resistance to stretch in spastic muscle “False” positive“False” negativeHealthy range
19Evaluation of muscle resistance by handheld dynamometer is well correlated to resistance measures by stationary deviceR2:0,711