Clinical Management of Spasticity and Contractures in Spinal Cord Injury

This chapter deals with the manifestation of spasticity in Spinal Cord Injury (SCI) and how it can be beneficial or detrimental to function. It describes particular features of SCI spasticity based on spinal syndromes and their pathophysiology. The anatomy of a human spinal lesion results in phenotypes with implications for functional deficits that have more effect on spasticity treatment than underlying pathophysiology of presumed neural interaction at the spinal segmental level. Spasticity in SCI as much as in other central nervous system (CNS) pathologies may be seen as a compensatory state of a deficit of sensory-motor control that is usually associated with a lower level of functional CNS organisation. Clinical signs of spasticity are not related to spastic movement disorder. In most surveys, spasticity is rated as the most disabling complication, followed by pain, sexual, bowel, and bladder dysfunction and pressure ulcers. There is an interrelation of spasticity, pain, reduced mobility, contractures, and pressure sores.