Publication Date

2008

Clinical Question

What evidence exists (published between 1988 and 2008) on the treatment of spinal cord injury related spasticity with Botulinum-Toxin and Transcutaneous Electrical Nerve Stimulation?

Clinical Bottom Line

Occupational therapists are mainly concerned that their patients can live their life as independent as possible, doing the meaningful activities that they desire to do. In our spinal cord injured patients, spasticity can be a problematic secondary effect that makes it difficult for them to participate fully in life. Research on the treatment of spasticity is so important for occupational therapists to know about in order to be an advocate for delivering the best treatment for our clients.

The interventions that were tested and found beneficial in the Level I-III studies reviewed here include using botulinum toxin injections and transcutaneous electrical nerve stimulation to address problematic spasticity. Occupational therapists can be involved in referring clients to receive BTX-A injections or be administers of TENS. Occupational therapists can assure their patients that these interventions have been tested and found successful in improving participation with some patients. One study suggested the importance of rehab therapies in conjunction with BTX-A injection treatments (Richardson, 2000). Overall, the four Level I-III studies have pointed towards BTX-A injections being the most effective in treating spinal cord injury related spasticity. The injections have a longer lasting effect and minimal adverse effects. TENS can be useful for some patients, and is non-invasive, but has a much shorter duration, requiring more treatments.

The experimental case report writers described the multi-disciplinary treatment, including BTX-A injections, in detail, but the literature review had inconclusive findings.

The ideal intervention for the treatment of spinal cord injury related spasticity is still unknown. Further research needs to be completed.

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