Spasticity Predicts Motor Recovery for Patients with Subacute Motor Complete Spinal Cord Injury

Sina Sangari, Bing Chen, Francis Grover, Hoda Salsabili, Manasi Sheth, Kavita Gohil, Sara Hobbs, Amanda Olson, Ines Eisner-Janowicz, Alan Anschel, Ki Kim, David Chen, Allison Kessler, Allen W. Heinemann, Martin Oudega, Brian K. Kwon, Steven Kirshblum, James D. Guest, Monica A. Perez*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Objective: A motor complete spinal cord injury (SCI) results in the loss of voluntary motor control below the point of injury. Some of these patients can regain partial motor function through inpatient rehabilitation; however, there is currently no biomarker to easily identify which patients have this potential. Evidence indicates that spasticity could be that marker. Patients with motor complete SCI who exhibit spasticity show preservation of descending motor pathways, the pathways necessary for motor signals to be carried from the brain to the target muscle. We hypothesized that the presence of spasticity predicts motor recovery after subacute motor complete SCI. Methods: Spasticity (Modified Ashworth Scale and pendulum test) and descending connectivity (motor evoked potentials) were tested in the rectus femoris muscle in patients with subacute motor complete (n = 36) and motor incomplete (n = 30) SCI. Motor recovery was assessed by using the International Standards for Neurological Classification of Spinal Cord Injury and the American Spinal Injury Association Impairment Scale (AIS). All measurements were taken at admission and discharge from inpatient rehabilitation. Results: We found that motor complete SCI patients with spasticity improved in motor scores and showed AIS conversion to either motor or sensory incomplete. Conversely, patients without spasticity showed no changes in motor scores and AIS conversion. In incomplete SCI patients, motor scores improved and AIS conversion occurred regardless of spasticity. Interpretation: These findings suggest that spasticity represents an easy-to-use clinical outcome that might help to predict motor recovery after severe SCI. This knowledge can improve inpatient rehabilitation effectiveness for motor complete SCI patients. ANN NEUROL 2024;95:71–86.

Original languageEnglish (US)
Pages (from-to)71-86
Number of pages16
JournalAnnals of neurology
Volume95
Issue number1
DOIs
StatePublished - Jan 2024

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

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