Impact of spasticity on transfers and activities of daily living in individuals with spinal cord injury

Abstract

Context/Objective: For persons with spinal cord injury, spasticity commonly interferes with activities of daily living such as transfers. Electromyography can be used to objectively measure muscle spasms during transfers, but how electromyographic measures relate to the impact spasticity has on life, or to clinically-rated spasticity, is unclear. We aimed to characterize relationships among spasm duration and magnitude, impact of spasticity on daily life, and a clinical measure of extensor spasticity, as well as to determine reliability of the electromyographic measures.

Design: Participants (N=19) underwent electromyographic measurements of involuntary muscle activity (spasm duration and magnitude) evoked in quadriceps muscles during transfers on two days. Impact of spasticity on daily life was measured with the Spinal Cord Injury Spasticity Evaluation Tool. Clinically-rated spasticity severity was measured with the Spinal Cord Assessment Tool for Spastic reflexes.

Results: No significant associations were found between impact of spasticity and spasm duration, spasm magnitude, or clinical extensor spasticity score. Absolute and normalized spasm duration were positively associated with clinical extensor spasticity score (rho=0.510-0.667, P < 0.05). Spasm measures during transfers had good to excellent day-to-day reliability (rho=0.656-0.846, P < 0.05).

Conclusions: Electromyographic and clinical measures of involuntary activity in the lower extremity do not significantly relate to perceived impact of spasticity on daily life. However, quadriceps spasm duration during transfers is related to clinically-rated extensor spasticity. Electromyography is a reliable method of quantifying quadriceps spasms during transfers. Future investigations should identify factors that influence the impact of spasticity on life, which may help direct treatment strategies to reduce problematic impact.

Keywords:

• Seated transfers
• Electromyography
• Spinal cord assessment tool for spastic reflexes
• Spinal cord injury spasticity evaluation tool
• Quadriceps spasms

Acknowledgements

The authors thank Aaisha Sanaullah, Jennifer Tibangin, James Adcock and Maydelis Escalona for their help with experimentation and data processing.

Disclaimer statements

Contributors None

Funding This study was supported by The Miami Project to Cure Paralysis.

Conflict of Interest Statement None.

Ethics approval The protocol was approved by the University of Miami Miller School of Medicine Institutional Review Board and conforms to the guidelines of the Declaration of Helsinki.

ORCID

Jacqueline Tibbett http://orcid.org/0000-0002-6807-5696

Eva G. Widerström-Noga http://orcid.org/0000-0003-0208-3658