Purpose: To provide an overview of evidence for spinal cord injury (SCI) spasticity interventions in peerreviewed, published literature. Method: Structured review and synthesis of spasticity treatments in the literature. Each publication was rated according to the Downs and Black methodology for assessing nonrandomized studies and according to the Physiotherapy Evidence Database (PEDro) scale for assessing randomized controlled trials. Results: Level 1 evidence supports the use of transcutaneous electrical nerve stimulation (TENS), penile vibration, baclofen, tizanidine, clonidine, cyproheptadine, gabapentin, and Lthreonine to reduce spasticity in SCI. Conclusion: Although spasticity is a common complication following SCI, there is relatively little evidence for the treatment of spasticity and even less evidence that has been confirmed by independent replication. TENS is the only routine nonpharmacological treatment for spasticity that is supported by adequate level 1 evidence. Several pharmacological treatments, including baclofen, tizanidine, and clonidine, are supported by level 1 evidence. There is level 1 evidence to support test doses of intrathecal baclofen for the short-term reduction of spasticity in SCI but not for its long-term use. The lack of level 1 evidence for spasticity interventions does not necessarily reflect a lack of effective treatments, but it does emphasize the need for further studies. All other interventions reviewed would benefit from further study.

clonus, hyperreflexia, hypertonia, intervention, paraplegia, quadriplegia, SCI, spasticity, spinal cord injury, tetraplegia, treatment
Levi R, Hultling C, Nash MS, Seiger A. The Stockholm spinal cord injury study: 1. Medical problems in a regional SCI population. Paraplegia. 1995;33:308–315.
,
The Stockholm spinal cord injury study: 1. Medical problems in a regional SCI population
,
Paraplegia
, vol.
33
(pg.
308
-
315
)
Maynard FM, Karunas RS, Waring WP III. Epidemiology of spasticity following traumatic spinal cord injury. Arch Phys Med Rehabil. 1990;71:566–569.
Waring WP, III. ,
Epidemiology of spasticity following traumatic spinal cord injury
,
Arch Phys Med Rehabil
,
1990
, vol.
(pg.
566
-
569
)
Google Scholar
 
Canadian Paraplegic Association. Workplace Participation National Survey of Canadians with SCI. Available at: http://www.canparaplegic.org/en/Employment_and_Education_24/EMPLOYMENT_6/14.html. Accessed January 10, 2007.
Lance JW. Symposium synopsis. In: Feldman RG, Young RR, Koella WP, eds. Spasticity: Disordered Motor Control. Chicago: Year Book Medical; 1980:485–494.
Lance, JW. ,
Symposium synopsis
,
Spasticity: Disordered Motor Control
,
1980
(pg.
485
-
494
)
Google Scholar
 
Pandyan AD, Gregoric M, Barnes MP, et al. Spasticity: clinical perceptions, neurological realities and meaningful measurement. Disabil Rehabil. 2005;27:2–6, (doi: 10.1080/09638280400014576).
et, al. ,
Spasticity: clinical perceptions, neurological realities and meaningful measurement
,
Disabil Rehabil
,
2005
, vol.
(pg.
2
-
6
)
Google Scholar
 
Ashworth B. Preliminary trial of carisoprodol in multiple sclerosis. Practitioner. 1964;192: 540–542.
Ashworth, B. ,
Preliminary trial of carisoprodol in multiple sclerosis
,
Practitioner
,
1964
, vol.
(pg.
540
-
542
)
Google Scholar
 
Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987;67:206–207.
Smith, MB. ,
Interrater reliability of a modified Ashworth scale of muscle spasticity
,
Phys Ther
,
1987
, vol.
(pg.
206
-
207
)
Google Scholar
 
Penn RD. Intrathecal baclofen for severe spasticity. Ann N Y Acad Sci. 1988;531:157–166, (doi: 10.1111/j.1749-6632.1988.tb31822.x).
Penn, RD. ,
Intrathecal baclofen for severe spasticity
,
Ann N Y Acad Sci
,
1988
, vol.
(pg.
157
-
166
)
Google Scholar
 
Benz EN, Hornby TG, Bode RK, Scheidt RA, Schmit BD. A physiologically based clinical measure for spastic reflexes in spinal cord injury. Arch Phys Med Rehabil. 2005;86:52–59, (doi: 10.1016/j.apmr.2004.01.033).
Schmit, BD. ,
A physiologically based clinical measure for spastic reflexes in spinal cord injury
,
Arch Phys Med Rehabil
,
2005
, vol.
(pg.
52
-
59
)
Google Scholar
 
Skold C. Spasticity in spinal cord injury: selfand clinically rated intrinsic fluctuations and intervention-induced changes. Arch Phys Med Rehabil. 2000;81:144–149, (doi: 10.1016/S0003-9993(00)90132-1).
Skold, C. ,
Spasticity in spinal cord injury: selfand clinically rated intrinsic fluctuations and intervention-induced changes
,
Arch Phys Med Rehabil
,
2000
, vol.
(pg.
144
-
149
)
Google Scholar
 
Aydin G, Tomruk S, Keles I, Demir SO, Orkun S. Transcutaneous electrical nerve stimulation versus baclofen in spasticity: clinical and electrophysiologic comparison. Am J Phys Med Rehabil. 2005;84:584–592, (doi: 10.1097/01.phm.0000171173.86312.69).
Orkun, S. ,
Transcutaneous electrical nerve stimulation versus baclofen in spasticity: clinical and electrophysiologic comparison
,
Am J Phys Med Rehabil
,
2005
, vol.
(pg.
584
-
592
)
Google Scholar
 
Goulet C, Arsenault AB, Bourbonnais D, Laramee MT, Lepage Y. Effects of transcutaneous electrical nerve stimulation on H-reflex and spinal spasticity. Scand J Rehabil Med. 1996;28:169–176.
Lepage, Y. ,
Effects of transcutaneous electrical nerve stimulation on H-reflex and spinal spasticity
,
Scand J Rehabil Med
,
1996
, vol.
(pg.
169
-
176
)
Google Scholar
 
Seib TP, Price R, Reyes MR, Lehmann JF. The quantitative measurement of spasticity: effect of cutaneous electrical stimulation. Arch Phys Med Rehabil. 1994;75:746–750.
Lehmann, JF. ,
The quantitative measurement of spasticity: effect of cutaneous electrical stimulation
,
Arch Phys Med Rehabil
,
1994
, vol.
(pg.
746
-
750
)
Google Scholar
 
Sherrington C, Herbert RD, Maher CG, Moseley AM. PEDro. A database of randomized trials and systematic reviews in physiotherapy. Man Ther. 2000;5:223–226, (doi: 10.1054/math.2000.0372).
Moseley, AM. ,
PEDro. A database of randomized trials and systematic reviews in physiotherapy
,
Man Ther
,
2000
, vol.
(pg.
223
-
226
)
Google Scholar
 
Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and nonrandomised studies of health care interventions. J Epidemiol Community Health. 1998;52:377–384.
Black, N. ,
The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and nonrandomised studies of health care interventions
,
J Epidemiol Community Health
,
1998
, vol.
(pg.
377
-
384
)
Google Scholar
 
Strauss SE, Richardson WS, Glasziou P, Haynes RB. Evidence-Based Medicine. How to Practice and Teach EBM. 4th ed. Edinburgh: Churchill Livingstone; 2005.
,
How to Practice and Teach EBM
,
Evidence-Based Medicine
Kirshblum S. Treatment alternatives for spinal cord injury related spasticity. J Spinal Cord Med. 1999;22:199–217.
Kirshblum, S. ,
Treatment alternatives for spinal cord injury related spasticity
,
J Spinal Cord Med
,
1999
, vol.
(pg.
199
-
217
)
Google Scholar
 
Merritt JL. Management of spasticity in spinal cord injury. Mayo Clin Proc. 1981;56:614–622.
Merritt, JL. ,
Management of spasticity in spinal cord injury
,
Mayo Clin Proc
,
1981
, vol.
(pg.
614
-
622
)
Google Scholar
 
Kakebeeke TH, Lechner HE, Knapp PA. The effect of passive cycling movements on spasticity after spinal cord injury: preliminary results. Spinal Cord. 2005;43:483–488, (doi: 10.1038/sj.sc.3101747).
Knapp, PA. ,
The effect of passive cycling movements on spasticity after spinal cord injury: preliminary results
,
Spinal Cord
,
2005
, vol.
(pg.
483
-
488
)
Google Scholar
 
Odeen I, Knutsson E. Evaluation of the effects of muscle stretch and weight load in patients with spastic paraplegia. Scand J Rehabil Med. 1981;13:117–121.
Knutsson, E. ,
Evaluation of the effects of muscle stretch and weight load in patients with spastic paraplegia
,
Scand J Rehabil Med
,
1981
, vol.
(pg.
117
-
121
)
Google Scholar
 
Kesiktas N, Paker N, Erdogan N, Gulsen G, Bicki D, Yilmaz H. The use of hydrotherapy for the management of spasticity. Neurorehabil Neural Repair. 2004;18:268–273, (doi: 10.1177/1545968304270002).
Yilmaz, H. ,
The use of hydrotherapy for the management of spasticity
,
Neurorehabil Neural Repair
,
2004
, vol.
(pg.
268
-
273
)
Google Scholar
 
Granat MH, Ferguson AC, Andrews BJ, Delargy M. The role of functional electrical stimulation in the rehabilitation of patients with incomplete spinal cord injury—observed benefits during gait studies. Paraplegia. 1993;31:207–215.
Delargy, M. ,
The role of functional electrical stimulation in the rehabilitation of patients with incomplete spinal cord injury—observed benefits during gait studies
,
Paraplegia
,
1993
, vol.
(pg.
207
-
215
)
Google Scholar
 
Mirbagheri MM, Ladouceur M, Barbeau H, Kearney RE. The effects of long-term FESassisted walking on intrinsic and reflex dynamic stiffness in spastic spinal-cord-injured subjects. IEEE Trans Neural Syst Rehabil Eng. 2002;10:280–289, (doi: 10.1109/TNSRE.2002.806838).
Kearney, RE. ,
The effects of long-term FESassisted walking on intrinsic and reflex dynamic stiffness in spastic spinal-cord-injured subjects
,
IEEE Trans Neural Syst Rehabil Eng
,
2002
, vol.
(pg.
280
-
289
)
Google Scholar
 
Thoumie P, Le CG, Beillot J, et al. Restoration of functional gait in paraplegic patients with the RGO-II hybrid orthosis. A multicenter controlled study. II: Physiological evaluation. Paraplegia. 1995;33:654–659.
et, al. ,
Restoration of functional gait in paraplegic patients with the RGO-II hybrid orthosis. A multicenter controlled study. II: Physiological evaluation
,
Paraplegia
,
1995
, vol.
(pg.
654
-
659
)
Google Scholar
 
van der Salm A, Veltink PH, Ijzerman MJ, Groothuis-Oudshoorn KC, Nene AV, Hermens HJ. Comparison of electric stimulation methods for reduction of triceps surae spasticity in spinal cord injury. Arch Phys Med Rehabil. 2006;87:222–228, (doi: 10.1016/j.apmr.2005.09.024).
Hermens, HJ. ,
Comparison of electric stimulation methods for reduction of triceps surae spasticity in spinal cord injury
,
Arch Phys Med Rehabil
,
2006
, vol.
(pg.
222
-
228
)
Google Scholar
 
Robinson CJ, Kett NA, Bolam JM. Spasticity in spinal cord injured patients: 1. Short-term effects of surface electrical stimulation. Arch Phys Med Rehabil. 1988;69:598–604.
,
Spasticity in spinal cord injured patients: 1. Short-term effects of surface electrical stimulation
,
Arch Phys Med Rehabil.
, vol.
69
(pg.
598
-
604
)
Robinson CJ, Kett NA, Bolam JM. Spasticity in spinal cord injured patients: 2. Initial measures and long-term effects of surface electrical stimulation. Arch Phys Med Rehabil. 1988;69:862–868.
,
Spasticity in spinal cord injured patients: 2. Initial measures and long-term effects of surface electrical stimulation
,
Arch Phys Med Rehabil.
, vol.
69
(pg.
862
-
868
)
Chen SC, Chen YL, Chen CJ, Lai CH, Chiang WH, Chen WL. Effects of surface electrical stimulation on the muscle-tendon junction of spastic gastrocnemius in stroke patients. Disabil Rehabil. 2005;27:105–110, (doi: 10.1080/09638280400009022).
Chen, WL. ,
Effects of surface electrical stimulation on the muscle-tendon junction of spastic gastrocnemius in stroke patients
,
Disabil Rehabil
,
2005
, vol.
(pg.
105
-
110
)
Google Scholar
 
Ozer K, Chesher SP, Scheker LR. Neuromuscular electrical stimulation and dynamic bracing for the management of upper-extremity spasticity in children with cerebral palsy. Dev Med Child Neurol. 2006;48:559–563, (doi: 10.1017/S0012162206001186).
Scheker, LR. ,
Neuromuscular electrical stimulation and dynamic bracing for the management of upper-extremity spasticity in children with cerebral palsy
,
Dev Med Child Neurol
,
2006
, vol.
(pg.
559
-
563
)
Google Scholar
 
Alaca R, Goktepe AS, Yildiz N, Yilmaz B, Gunduz S. Effect of penile vibratory stimulation on spasticity in men with spinal cord injury. Am J Phys Med Rehabil. 2005;84:875–879, (doi: 10.1097/01.phm.0000184235.32803.ca).
Gunduz, S. ,
Effect of penile vibratory stimulation on spasticity in men with spinal cord injury
,
Am J Phys Med Rehabil
,
2005
, vol.
(pg.
875
-
879
)
Google Scholar
 
Laessoe L, Nielsen JB, Biering-Sorensen F, Sonksen J. Antispastic effect of penile vibration in men with spinal cord lesion. Arch Phys Med Rehabil. 2004;85:919–924, (doi: 10.1016/j.apmr.2003.08.082).
Sonksen, J. ,
Antispastic effect of penile vibration in men with spinal cord lesion
,
Arch Phys Med Rehabil
,
2004
, vol.
(pg.
919
-
924
)
Google Scholar
 
Halstead LS, Seager SW, Houston JM, Whitesell K, Dennis M, Nance PW. Relief of spasticity in SCI men and women using rectal probe electrostimulation. Paraplegia. 1993; 31:715–721.
Nance, PW. ,
Relief of spasticity in SCI men and women using rectal probe electrostimulation
,
Paraplegia
,
1993
, vol.
(pg.
715
-
721
)
Google Scholar
 
Goldberg J, Seaborne DE, Sullivan SJ, Leduc BE. The effect of therapeutic massage on H-reflex amplitude in persons with a spinal cord injury. Phys Ther. 1994;74:728–737.
Leduc, BE. ,
The effect of therapeutic massage on H-reflex amplitude in persons with a spinal cord injury
,
Phys Ther
,
1994
, vol.
(pg.
728
-
737
)
Google Scholar
 
Price R, Lehmann JF, Boswell-Bessette S, Burleigh A, deLateur BJ. Influence of cryotherapy on spasticity at the human ankle. Arch Phys Med Rehabil. 1993;74:300–304.
deLateur, BJ. ,
Influence of cryotherapy on spasticity at the human ankle
,
Arch Phys Med Rehabil
,
1993
, vol.
(pg.
300
-
304
)
Google Scholar
 
Lechner HE, Feldhaus S, Gudmundsen L, et al. The short-term effect of hippotherapy on spasticity in patients with spinal cord injury. Spinal Cord. 2003;41:502–505, (doi: 10.1038/sj.sc.3101492).
et, al. ,
The short-term effect of hippotherapy on spasticity in patients with spinal cord injury
,
Spinal Cord
,
2003
, vol.
(pg.
502
-
505
)
Google Scholar
 
Walker JB. Temporary suppression of clonus in humans by brief photostimulation. Brain Res. 1985;340:109–113, (doi: 10.1016/0006-8993(85)90779-6).
Walker, JB. ,
Temporary suppression of clonus in humans by brief photostimulation
,
Brain Res
,
1985
, vol.
(pg.
109
-
113
)
Google Scholar
 
Bajd T, Gregoric M, Vodovnik L, Benko H. Electrical stimulation in treating spasticity resulting from spinal cord injury. Arch Phys Med Rehabil. 1985;66:515–517.
Benko, H. ,
Electrical stimulation in treating spasticity resulting from spinal cord injury
,
Arch Phys Med Rehabil
,
1985
, vol.
(pg.
515
-
517
)
Google Scholar
 
Pinter MM, Gerstenbrand F, Dimitrijevic MR. Epidural electrical stimulation of posterior structures of the human lumbosacral cord: 3. Control of spasticity. Spinal Cord. 2000;38:524–531, (doi: 10.1038/sj.sc.3101040).
,
Epidural electrical stimulation of posterior structures of the human lumbosacral cord: 3. Control of spasticity
,
Spinal Cord
, vol.
38
(pg.
524
-
531
)
Barolat G, Singh-Sahni K, Staas WE Jr, Shatin D, Ketcik B, Allen K. Epidural spinal cord stimulation in the management of spasms in spinal cord injury: a prospective study. Stereotact Funct Neurosurg. 1995;64:153–164.
Allen, K. ,
Epidural spinal cord stimulation in the management of spasms in spinal cord injury: a prospective study
,
Stereotact Funct Neurosurg
,
1995
, vol.
(pg.
153
-
164
)
Google Scholar
 
Midha M, Schmitt JK. Epidural spinal cord stimulation for the control of spasticity in spinal cord injury patients lacks long-term efficacy and is not cost-effective. Spinal Cord. 1998;36:190–192, (doi: 10.1038/sj.sc.3100532).
Schmitt, JK. ,
Epidural spinal cord stimulation for the control of spasticity in spinal cord injury patients lacks long-term efficacy and is not cost-effective
,
Spinal Cord
,
1998
, vol.
(pg.
190
-
192
)
Google Scholar
 
Livshits A, Rappaport ZH, Livshits V, Gepstein R. Surgical treatment of painful spasticity after spinal cord injury. Spinal Cord. 2002;40:161–166, (doi: 10.1038/sj.sc.3101236).
Gepstein, R. ,
Surgical treatment of painful spasticity after spinal cord injury
,
Spinal Cord
,
2002
, vol.
(pg.
161
-
166
)
Google Scholar
 
Fogel JP, Waters RL, Mahomar F. Dorsal myelotomy for relief of spasticity in spinal injury patients. Clin Orthop. 1985;137–141.
,
Dorsal myelotomy for relief of spasticity in spinal injury patients
,
Clin Orthop.
(pg.
137
-
141
)
Putty TK, Shapiro SA. Efficacy of dorsal longitudinal myelotomy in treating spinal spasticity: a review of 20 cases. J Neurosurg. 1991;75:397–401.
,
Efficacy of dorsal longitudinal myelotomy in treating spinal spasticity: a review of 20 cases
,
J Neurosurg.
, vol.
75
(pg.
397
-
401
)
Taricco M, Pagliacci MC, Telaro E, Adone R. Pharmacological interventions for spasticity following spinal cord injury: results of a Cochrane systematic review. Eur Medicophys. 2006;42:5–15.
Adone, R. ,
Pharmacological interventions for spasticity following spinal cord injury: results of a Cochrane systematic review
,
Eur Medicophys
,
2006
, vol.
(pg.
5
-
15
)
Google Scholar
 
Chou R, Peterson K, Helfand M. Comparative efficacy and safety of skeletal muscle relaxants for spasticity and musculoskeletal conditions: a systematic review. J Pain Symptom Manage. 2004;28:140–175, (doi: 10.1016/j.jpainsymman.2004.05.002).
Helfand, M. ,
Comparative efficacy and safety of skeletal muscle relaxants for spasticity and musculoskeletal conditions: a systematic review
,
J Pain Symptom Manage
,
2004
, vol.
(pg.
140
-
175
)
Google Scholar
 
Burke D, Gillies JD, Lance JW. An objective assessment of a gamma aminobutyric acid derivative in the control of spasticity. Proc Aust Assoc Neurol. 1971;8:131–134.
Lance, JW. ,
An objective assessment of a gamma aminobutyric acid derivative in the control of spasticity
,
Proc Aust Assoc Neurol
,
1971
, vol.
(pg.
131
-
134
)
Google Scholar
 
Duncan GW, Shahani BT, Young RR. An evaluation of baclofen treatment for certain symptoms in patients with spinal cord lesions. A double-blind, cross-over study. Neurology. 1976;26:441–446.
Young, RR. ,
An evaluation of baclofen treatment for certain symptoms in patients with spinal cord lesions. A double-blind, cross-over study
,
Neurology
,
1976
, vol.
(pg.
441
-
446
)
Google Scholar
 
Nance PW. A comparison of clonidine, cyproheptadine and baclofen in spastic spinal cord injured patients. J Am Paraplegia Soc. 1994;17:150–156.
Nance, PW. ,
A comparison of clonidine, cyproheptadine and baclofen in spastic spinal cord injured patients
,
J Am Paraplegia Soc
,
1994
, vol.
(pg.
150
-
156
)
Google Scholar
 
Hinderer SR, Lehmann JF, Price R, White O, deLateur BJ, Deitz J. Spasticity in spinal cord injured persons: quantitative effects of baclofen and placebo treatments. Am J Phys Med Rehabil. 1990;69:311–317, (doi: 10.1097/00002060-199012000-00007).
Deitz, J. ,
Spasticity in spinal cord injured persons: quantitative effects of baclofen and placebo treatments
,
Am J Phys Med Rehabil
,
1990
, vol.
(pg.
311
-
317
)
Google Scholar
 
Loubser PG, Narayan RK, Sandin KJ, Donovan WH, Russell KD. Continuous infusion of intrathecal baclofen: long-term effects on spasticity in spinal cord injury. Paraplegia. 1991;29:48–64.
Russell, KD. ,
Continuous infusion of intrathecal baclofen: long-term effects on spasticity in spinal cord injury
,
Paraplegia
,
1991
, vol.
(pg.
48
-
64
)
Google Scholar
 
Coffey JR, Cahill D, Steers W, et al. Intrathecal baclofen for intractable spasticity of spinal origin: results of a long-term multicenter study. J Neurosurg. 1993;78:226–232.
et, al. ,
Intrathecal baclofen for intractable spasticity of spinal origin: results of a long-term multicenter study
,
J Neurosurg
,
1993
, vol.
(pg.
226
-
232
)
Google Scholar
 
Nance P, Schryvers O, Schmidt B, Dubo H, Loveridge B, Fewer D. Intrathecal baclofen therapy for adults with spinal spasticity: therapeutic efficacy and effect on hospital admissions. Can J Neurol Sci. 1995;22:22–29.
Fewer, D. ,
Intrathecal baclofen therapy for adults with spinal spasticity: therapeutic efficacy and effect on hospital admissions
,
Can J Neurol Sci
,
1995
, vol.
(pg.
22
-
29
)
Google Scholar
 
Ordia JI, Fischer E, Adamski E, Spatz EL. Chronic intrathecal delivery of baclofen by a programmable pump for the treatment of severe spasticity. J Neurosurg. 1996;85:452–457.
Spatz, EL. ,
Chronic intrathecal delivery of baclofen by a programmable pump for the treatment of severe spasticity
,
J Neurosurg
,
1996
, vol.
(pg.
452
-
457
)
Google Scholar
 
Penn RD, Savoy SM, Corcos D, et al. Intrathecal baclofen for severe spinal spasticity. N Engl J Med. 1989;320:1517–1521.
et, al. ,
Intrathecal baclofen for severe spinal spasticity
,
N Engl J Med
,
1989
, vol.
(pg.
1517
-
1521
)
Google Scholar
 
Parke B, Penn RD, Savoy SM, Corcos D. Functional outcome after delivery of intrathecal baclofen. Arch Phys Med Rehabil. 1989;70:30–32.
Corcos, D. ,
Functional outcome after delivery of intrathecal baclofen
,
Arch Phys Med Rehabil
,
1989
, vol.
(pg.
30
-
32
)
Google Scholar
 
Plassat R, Perrouin-Verbe B, Menei P, Menegalli D, Mathe JF, Richard I. Treatment of spasticity with intrathecal Baclofen administration: long-term follow-up, review of 40 patients. Spinal Cord. 2004;42:686–693, (doi: 10.1038/sj.sc.3101647).
,
Treatment of spasticity with intrathecal Baclofen administration: long-term follow-up, review of 40 patients
,
Spinal Cord
, vol.
42
(pg.
686
-
693
)
Azouvi P, Mane M, Thiebaut JB, Denys P, Remy-Neris O, Bussel B. Intrathecal baclofen administration for control of severe spinal spasticity: functional improvement and longterm follow-up. Arch Phys Med Rehabil. 1996;77:35–39, (doi: 10.1016/S0003-9993(96)90217-8).
Bussel, B. ,
Intrathecal baclofen administration for control of severe spinal spasticity: functional improvement and longterm follow-up
,
Arch Phys Med Rehabil
,
1996
, vol.
(pg.
35
-
39
)
Google Scholar
 
Boviatsis EJ, Kouyialis AT, Korfias S, Sakas DE. Functional outcome of intrathecal baclofen administration for severe spasticity. Clin Neurol Neurosurg. 2005;107:289–295, (doi: 10.1016/j.clineuro.2004.09.007).
Sakas, DE. ,
Functional outcome of intrathecal baclofen administration for severe spasticity
,
Clin Neurol Neurosurg
,
2005
, vol.
(pg.
289
-
295
)
Google Scholar
 
Broseta J, Garcia-March G, Sanchez-Ledesma MJ, Anaya J, Silva I. Chronic intrathecal baclofen administration in severe spasticity. Stereotact Funct Neurosurg. 1990;54–55:147–153, (doi: 10.1159/000100205).
,
Chronic intrathecal baclofen administration in severe spasticity
,
Stereotact Funct Neurosurg.
(pg.
54,147
-
55,153
)
Korenkov AI, Niendorf WR, Darwish N, Glaeser E, Gaab MR. Continuous intrathecal infusion of baclofen in patients with spasticity caused by spinal cord injuries. Neurosurg Rev. 2002;25:228–230, (doi: 10.1007/s10143-002-0221-1).
Gaab, MR. ,
Continuous intrathecal infusion of baclofen in patients with spasticity caused by spinal cord injuries
,
Neurosurg Rev
,
2002
, vol.
(pg.
228
-
230
)
Google Scholar
 
Zahavi A, Geertzen JH, Middel B, Staal M, Rietman JS. Long term effect (more than five years) of intrathecal baclofen on impairment, disability, and quality of life in patients with severe spasticity of spinal origin. J Neurol Neurosurg Psychiatry. 2004;75:1553–1557, (doi: 10.1136/jnnp.2003.014282).
Rietman, JS. ,
Long term effect (more than five years) of intrathecal baclofen on impairment, disability, and quality of life in patients with severe spasticity of spinal origin
,
J Neurol Neurosurg Psychiatry
,
2004
, vol.
(pg.
1553
-
1557
)
Google Scholar
 
Abel NA, Smith RA. Intrathecal baclofen for treatment of intractable spinal spasticity. Arch Phys Med Rehabil. 1994;75:54–58.
Smith, RA. ,
Intrathecal baclofen for treatment of intractable spinal spasticity
,
Arch Phys Med Rehabil
,
1994
, vol.
(pg.
54
-
58
)
Google Scholar
 
Ochs G, Struppler A, Meyerson BA, et al. Intrathecal baclofen for long-term treatment of spasticity: a multi-centre study. J Neurol Neurosurg Psychiatry. 1989;52:933–939.
et, al. ,
Intrathecal baclofen for long-term treatment of spasticity: a multi-centre study
,
J Neurol Neurosurg Psychiatry
,
1989
, vol.
(pg.
933
-
939
)
Google Scholar
 
Penn RD. Intrathecal baclofen for spasticity of spinal origin: seven years of experience. J Neurosurg. 1992;77:236–240.
Penn, RD. ,
Intrathecal baclofen for spasticity of spinal origin: seven years of experience
,
J Neurosurg
,
1992
, vol.
(pg.
236
-
240
)
Google Scholar
 
Nance PW, Bugaresti J, Shellenberger K, Sheremata W, Martinez-Arizala A. Efficacy and safety of tizanidine in the treatment of spasticity in patients with spinal cord injury. North American Tizanidine Study Group. Neurology. 1994;44:S44–S51.
Martinez-Arizala, A. ,
Efficacy and safety of tizanidine in the treatment of spasticity in patients with spinal cord injury. North American Tizanidine Study Group
,
Neurology
,
1994
, vol.
(pg.
S44
-
S51
)
Google Scholar
 
Mathias CJ, Luckitt J, Desai P, Baker H, el Masri W, Frankel HL. Pharmacodynamics and pharmacokinetics of the oral antispastic agent tizanidine in patients with spinal cord injury. J Rehabil Res Dev. 1989;26:9–16.
Frankel, HL. ,
Pharmacodynamics and pharmacokinetics of the oral antispastic agent tizanidine in patients with spinal cord injury
,
J Rehabil Res Dev
,
1989
, vol.
(pg.
9
-
16
)
Google Scholar
 
Donovan WH, Carter RE, Rossi CD, Wilkerson MA. Clonidine effect on spasticity: a clinical trial. Arch Phys Med Rehabil. 1988;69:193–194.
Wilkerson, MA. ,
Clonidine effect on spasticity: a clinical trial
,
Arch Phys Med Rehabil
,
1988
, vol.
(pg.
193
-
194
)
Google Scholar
 
Nance PW, Shears AH, Nance DM. Reflex changes induced by clonidine in spinal cord injured patients. Paraplegia. 1989;27:296–301.
Nance, DM. ,
Reflex changes induced by clonidine in spinal cord injured patients
,
Paraplegia
,
1989
, vol.
(pg.
296
-
301
)
Google Scholar
 
Remy-Neris O, Barbeau H, Daniel O, Boiteau F, Bussel B. Effects of intrathecal clonidine injection on spinal reflexes and human locomotion in incomplete paraplegic subjects. Exp Brain Res. 1999;129:433–440, (doi: 10.1007/s002210050910).
Bussel, B. ,
Effects of intrathecal clonidine injection on spinal reflexes and human locomotion in incomplete paraplegic subjects
,
Exp Brain Res
,
1999
, vol.
(pg.
433
-
440
)
Google Scholar
 
Remy-Neris O, Denys P, Bussel B. Intrathecal clonidine for controlling spastic hypertonia. Phys Med Rehabil Clin N Am. 2001;12:939–951, ix.
Bussel, B. ,
Intrathecal clonidine for controlling spastic hypertonia
,
Phys Med Rehabil Clin N Am
,
2001
, vol.
(pg.
939
-
951
)
Google Scholar
 
Stewart JE, Barbeau H, Gauthier S. Modulation of locomotor patterns and spasticity with clonidine in spinal cord injured patients. Can J Neurol Sci. 1991;18:321–332.
Gauthier, S. ,
Modulation of locomotor patterns and spasticity with clonidine in spinal cord injured patients
,
Can J Neurol Sci
,
1991
, vol.
(pg.
321
-
332
)
Google Scholar
 
Weingarden SI, Belen JG. Clonidine transdermal system for treatment of spasticity in spinal cord injury. Arch Phys Med Rehabil. 1992;73:876–877.
Belen, JG. ,
Clonidine transdermal system for treatment of spasticity in spinal cord injury
,
Arch Phys Med Rehabil
,
1992
, vol.
(pg.
876
-
877
)
Google Scholar
 
Yablon SA, Sipski ML. Effect of transdermal clonidine on spinal spasticity. A case series. Am J Phys Med Rehabil. 1993;72:154–157, (doi: 10.1097/00002060-199306000-00009).
Sipski, ML. ,
Effect of transdermal clonidine on spinal spasticity. A case series
,
Am J Phys Med Rehabil
,
1993
, vol.
(pg.
154
-
157
)
Google Scholar
 
Donovan WH, Halter JA, Graves DE, et al. Intravenous infusion of 4-AP in chronic spinal cord injured subjects. Spinal Cord. 2000;38: 7–15.
,
Intravenous infusion of 4-AP in chronic spinal cord injured subjects
,
Spinal Cord
, vol.
38
(pg.
7
-
15
)
Hayes KC, Potter PJ, Wolfe DL, Hsieh JT, Delaney GA, Blight AR. 4-Aminopyridine-sensitive neurologic deficits in patients with spinal cord injury. J Neurotrauma. 1994;11: 433–446.
,
4-Aminopyridine-sensitive neurologic deficits in patients with spinal cord injury
,
J Neurotrauma
, vol.
11
(pg.
433
-
446
)
Potter PJ, Hayes KC, Segal JL, et al. Randomized double-blind crossover trial of fampridine-SR (sustained release 4-amino-pyridine) in patients with incomplete spinal cord injury. J Neurotrauma. 1998;15:837–849.
,
Randomized double-blind crossover trial of fampridine-SR (sustained release 4-amino-pyridine) in patients with incomplete spinal cord injury
,
J Neurotrauma
, vol.
15
(pg.
837
-
849
)
Potter PJ, Hayes KC, Hsieh JT, Delaney GA, Segal JL. Sustained improvements in neurological function in spinal cord injured patients treated with oral 4-aminopyridine: three cases. Spinal Cord. 1998;36:147–155, (doi: 10.1038/sj.sc.3100559).
,
Sustained improvements in neurological function in spinal cord injured patients treated with oral 4-aminopyridine: three cases
,
Spinal Cord
, vol.
36
(pg.
147
-
155
)
Wainberg M, Barbeau H, Gauthier S. The effects of cyproheptadine on locomotion and on spasticity in patients with spinal cord injuries. J Neurol Neurosurg Psychiatry. 1990;53:754–763.
Gauthier, S. ,
The effects of cyproheptadine on locomotion and on spasticity in patients with spinal cord injuries
,
J Neurol Neurosurg Psychiatry
,
1990
, vol.
(pg.
754
-
763
)
Google Scholar
 
Barbeau H, Richards CL, Bedard PJ. Action of cyproheptadine in spastic paraparetic patients. J Neurol Neurosurg Psychiatry. 1982;45:923–926.
Bedard, PJ. ,
Action of cyproheptadine in spastic paraparetic patients
,
J Neurol Neurosurg Psychiatry
,
1982
, vol.
(pg.
923
-
926
)
Google Scholar
 
Gruenthal M, Mueller M, Olson WL, Priebe MM, Sherwood AM, Olson WH. Gabapentin for the treatment of spasticity in patients with spinal cord injury. Spinal Cord. 1997;35:686–689, (doi: 10.1038/sj.sc.3100481).
Olson, WH. ,
Gabapentin for the treatment of spasticity in patients with spinal cord injury
,
Spinal Cord
,
1997
, vol.
(pg.
686
-
689
)
Google Scholar
 
Priebe MM, Sherwood AM, Graves DE, Mueller M, Olson WH. Effectiveness of gabapentin in controlling spasticity: a quantitative study. Spinal Cord. 1997;35:171–175, (doi: 10.1038/sj.sc.3100366).
Olson, WH. ,
Effectiveness of gabapentin in controlling spasticity: a quantitative study
,
Spinal Cord
,
1997
, vol.
(pg.
171
-
175
)
Google Scholar
 
Lee A, Patterson V. A double-blind study of Lthreonine in patients with spinal spasticity. Acta Neurol Scand. 1993;88:334–338.
Patterson, V. ,
A double-blind study of Lthreonine in patients with spinal spasticity
,
Acta Neurol Scand
,
1993
, vol.
(pg.
334
-
338
)
Google Scholar
 
Hagenbach U, Luz S, Ghafoor N, et al. The treatment of spasticity with Delta(9)-tetrahydrocannabinol in persons with spinal cord injury. Spinal Cord. Advance online publication. 2006 Oct 17; (Epub ahead of print). Medline CrossRef
Hollister LE. Marihuana in man: three years later. Science. 1971;172:21–29, (doi: 10.1126/science.172.3978.21).
Hollister, LE. ,
Marihuana in man: three years later
,
Science
,
1971
, vol.
(pg.
21
-
29
)
Google Scholar
 
Brin MF. Dosing, administration, and a treatment algorithm for use of botulinum toxin A for adult-onset spasticity. Spasticity Study Group. Muscle Nerve Suppl. 1997;6:S208–S220, (doi: 10.1002/(SICI)1097-4598(1997)6+<208::AID-MUS15>3.3.CO;2-9).
Brin, MF. ,
Dosing, administration, and a treatment algorithm for use of botulinum toxin A for adult-onset spasticity. Spasticity Study Group
,
Muscle Nerve Suppl
,
1997
, vol.
(pg.
S208
-
S220
)
Google Scholar
 
Fried GW, Fried KM. Spinal cord injury and use of botulinum toxin in reducing spasticity. Phys Med Rehabil Clin N Am. 2003;14:901–910.
Fried, KM. ,
Spinal cord injury and use of botulinum toxin in reducing spasticity
,
Phys Med Rehabil Clin N Am
,
2003
, vol.
(pg.
901
-
910
)
Google Scholar
 
Keren O, Shinberg F, Catz A, Giladi N. Botulin toxin for spasticity in spinal cord damage by treating the motor endplate. Harefuah. 2000;138:204–208.
Giladi, N. ,
Botulin toxin for spasticity in spinal cord damage by treating the motor endplate
,
Harefuah
,
2000
, vol.
(pg.
204
-
208
)
Google Scholar
 
Oechsner M. Treatment of hip adductor spasticity with botulinum toxin type B. Nervenarzt. 2002;73:1179–1182.
Oechsner, M. ,
Treatment of hip adductor spasticity with botulinum toxin type B
,
Nervenarzt
,
2002
, vol.
(pg.
1179
-
1182
)
Google Scholar
 
Takenaga S, Kawahigashi Y, Sonoda Y, et al. Treatment of spastic paraparesis with botulinum toxin with reference to beneficial effects, disease severity and long-term treatment. Rinsho Shinkeigaku. 1995;35:251–255.
et, al. ,
Treatment of spastic paraparesis with botulinum toxin with reference to beneficial effects, disease severity and long-term treatment
,
Rinsho Shinkeigaku
,
1995
, vol.
(pg.
251
-
255
)
Google Scholar
 
Richardson D, Edwards S, Sheean GL, Greenwood RJ, Thompson AJ. The effect of botulinum toxin on hand function after incomplete spinal cord injury at the level of C5/6: a case report. Clin Rehabil. 1997;11:288–292.
,
The effect of botulinum toxin on hand function after incomplete spinal cord injury at the level of C5/6: a case report
,
Clin Rehabil.
, vol.
11
(pg.
288
-
292
)
Al-Khodairy AT, Gobelet C, Rossier AB. Has botulinum toxin type A a place in the treatment of spasticity in spinal cord injury patients? Spinal Cord. 1998;36:854–858, (doi: 10.1038/sj.sc.3100703).
Rossier, AB. ,
Has botulinum toxin type A a place in the treatment of spasticity in spinal cord injury patients
,
Spinal Cord
,
1998
, vol.
(pg.
854
-
858
)
Google Scholar
 
Richardson D, Sheean G, Werring D, et al. Evaluating the role of botulinum toxin in the management of focal hypertonia in adults. J Neurol Neurosurg Psychiatry. 2000;69:499–506, (doi: 10.1136/jnnp.69.4.499).
et, al. ,
Evaluating the role of botulinum toxin in the management of focal hypertonia in adults
,
J Neurol Neurosurg Psychiatry
,
2000
, vol.
(pg.
499
-
506
)
Google Scholar
 
Ashworth B. Preliminary trial of carisoprodol in multiple sclerosis. Practitioner. 1964;192:540–542.
Ashworth, B. ,
Preliminary trial of carisoprodol in multiple sclerosis
,
Practitioner
,
1964
, vol.
(pg.
540
-
542
)
Google Scholar
 
Priebe MM, Sherwood AM, Thornby JI, Kharas NF, Markowski J. Clinical assessment of spasticity in spinal cord injury: a multidimensional problem. Arch Phys Med Rehabil. 1996; 77:713–716, (doi: 10.1016/S0003-9993(96)90014-3).
Markowski, J. ,
Clinical assessment of spasticity in spinal cord injury: a multidimensional problem
,
Arch Phys Med Rehabil
,
1996
, vol.
(pg.
713
-
716
)
Google Scholar
 
Priebe MM. Assessment of spinal cord injury spasticity in clinical trials. Top Spinal Cord Inj Rehabil. 2006;11:69–77.
Priebe, MM. ,
Assessment of spinal cord injury spasticity in clinical trials
,
Top Spinal Cord Inj Rehabil
,
2006
, vol.
(pg.
69
-
77
)
Google Scholar
 
Gracies JM, Nance P, Elovic E, McGuire J, Simpson DM. Traditional pharmacological treatments for spasticity. Part II: General and regional treatments. Muscle Nerve Suppl. 1997;6:S92–120, (doi: 10.1002/(SICI)1097-4598(1997)6+<92::AID-MUS7>3.0.CO;2-E).
Simpson, DM. ,
Traditional pharmacological treatments for spasticity. Part II: General and regional treatments
,
Muscle Nerve Suppl
,
1997
, vol.
(pg.
S92
-
120
)
Google Scholar
 
Dones I, Nazzi V, Broggi G. The guidelines for the diagnosis and treatment of spasticity. J Neurosurg Sci. 2006;50:101–105.
Broggi, G. ,
The guidelines for the diagnosis and treatment of spasticity
,
J Neurosurg Sci
,
2006
, vol.
(pg.
101
-
105
)
Google Scholar
 
Broderick CP, Radnitz CL, Bauman WA. Diazepam usage in veterans with spinal cord injury. J Spinal Cord Med. 1997;20:406–409.
Bauman, WA. ,
Diazepam usage in veterans with spinal cord injury
,
J Spinal Cord Med
,
1997
, vol.
(pg.
406
-
409
)
Google Scholar
 
Meythaler JM. Challenges of spastic hypertonia: spinal cord injury infosheet (UAB). Available at: http://images.main.uab.edu/spinalcord/pdffiles/16spasm.pdf. Accessed March 3, 2007.
Stempien L, Tsai T. Intrathecal baclofen pump use for spasticity: a clinical survey. Am J Phys Med Rehabil. 2000;79:536–541, (doi: 10.1097/00002060-200011000-00010).
Tsai, T. ,
Intrathecal baclofen pump use for spasticity: a clinical survey
,
Am J Phys Med Rehabil
,
2000
, vol.
(pg.
536
-
541
)
Google Scholar
 
Miller WC, Curt A, Elliot S, et al. Outcome measures. In: Eng JJ, Teasell RW, Miller WC, et al., eds. Spinal Cord Injury Rehabilitation Evidence (SCIRE). Vancouver: International Collaboration on Repair Discoveries; 2006:22-1-22-89.
et, al. ,
Outcome measures
,
Spinal Cord Injury Rehabilitation Evidence (SCIRE)
,
2006
(pg.
22
-
21
)
Google Scholar
 
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