Spasticity after Spinal Cord Injury Part 2- Treatment

Spasticity is a common complication after spinal cord injury (SCI) within the upper motor neuron syndrome. We describe it in 2 parts: in the first one (Part 1) the pathophysiology, clinical features and assessment are shown, and in this part (Part 2) its treatment will be considered. Once it has been decided to treat spasticity, the treatment is based on starting with simpler and less problematic activities, and increasing in complexity the procedures against spasticity. The possibilities of therapy with its characteristics are described: control of triggering factors, positioning, physical modalities (stretching, muscle strengthening, cold, splinting/ orthoses, electrical stimulation, robotic devices), oral medication (baclofen, diazepam, clonazepam, tizanidine, clonidine, and cannabinoids), intrathecal baclofen, local injections (phenol, botulinum toxin) or surgical interventions. In order to assess the effectiveness of the different applied treatments we must measure outcomes. A management protocol is proposed for the spasticity of the SCI patient.