post-spinal cord injury spasticity

Spasticity is one of the most common complications in spinal cord injury patients. According to statistics, more than 120 million people around the world are affected by spasticity, and more than half of the spasticity needs treatment.Sköld’s investigation and research on 354 cases of spinal cord injury patients found that 12%~37% of spasticity occurred in patients with spinal cord injury, and others found that the proportion of spasticity in patients with chronic spinal cord injury (one year after the injury) reached 65%~78%. In China, Chen Jun found that spasticity occurred in 12 cases (66.7%) of 18 spinal cord injury patients. After spinal cord injury, patients with spasticity lose selective motor control, have abnormal sitting posture, transfer and balance disorders, and walking difficulties. Eating, dressing and other daily life activities are restricted, and even lead to depression and other psychological disorders, which reduces the patients’ motivation to actively cooperate with the rehabilitation treatment and affects their physical and mental health.In addition, spasticity complicating patients after spinal cord injury will increase the difficulty of nursing care, increase the medical cost, and may lead to secondary hospitalization because of spasticity.Paker et al. reported that 25% of the secondary hospitalization was caused by spasticity, which is comparable to other complications that lead to secondary hospitalization. Spasticity is the most common cause of re-hospitalization in spinal cord injury patients when compared to other complications that lead to secondary hospitalization. Spasticity after spinal cord injury is a complex pathophysiologic phenomenon, and the mechanism of its occurrence is not fully understood. Most scholars believe that myospasm after spinal cord injury may result from damage to the downward motor pathway of the brainstem, and that the presence of spasticity can be observed in lesions at any level along this pathway. Myospasm is a form of resistance to passive flexion and extension of the limb and is caused by the muscle’s pull reflex, which can originate from diminished inhibitory influences on descending segments or from abnormalities in the neural control of muscle contraction. Normal skeletal muscle of the muscle spindle of the spindle muscle receives innervation of the anterior horn of the spinal cord γ motor neurons, the spiral receptors of the spindle muscle are extremely sensitive to muscle pull, when the muscle is subjected to passive pull or excitation of the γ motor neurons caused by the contraction of the spindle muscle, through the afferent nerves of the receptor, through the posterior root of the impulse into the gray matter of the spinal cord, with the anterior horn and the γ motor neuron constitutes the excitatory synapses, and then the α fibers outward, causing skeletal muscle Contraction. Rapidly conducting Ia fibers conduct action potentials centrally from the primary endings of the nucleus accumbens and nucleus strand of the muscle, which also responds to tonic stimuli, and they conduct their action potentials centrally through class II fibers. From this these neurons can activate either flexor or extensor muscles while inhibiting their respective antagonist muscles. In general, spasticity arises due to increased excitation of alpha motor neurons caused by damage to the brainstem downstream motor pathway. The most important current hypothesis suggests that myospasm arises primarily from diminished central inhibition during reflexes, with concomitant enhancement of central excitation. There are many treatment methods for myospasm caused by spinal cord injury, such as exercise therapy, drug therapy, phenol block therapy, transcutaneous electrical nerve stimulation, rectal electrical stimulation and selective posterior spinal nerve rhizotomy. When spasticity can not be relieved well by drugs and other methods, surgery can be considered. 1-2% of patients need surgical treatment by selective posterior spinal nerve rhizotomy, myelotomy, and orthopedic treatment (such as selective tendon severance and lengthening of Achilles tendon, etc.). Although there are many treatment methods for spasticity, none of them can fundamentally and effectively solve the pain of patients. Comprehensive research at home and abroad in recent years has found that physical therapy and anti-spasmodic drug therapy have been the main means of clinical treatment of spasticity after spinal cord injury, but it has the shortcomings of long course of treatment, slow onset of effect, and many toxic side effects of drugs. Nerve block therapy has a better short-term anti-spasmodic effect, but it must be combined with rehabilitation training to achieve better results. Although there are more kinds of drugs for the treatment of post-spinal cord injury myalgias, there is no drug that can completely alleviate or cure the disease, and there are some limitations in surgical treatment. As the characteristics and advantages of Chinese medicine are macroscopic grasping and overall regulation, the basic thinking of its clinical prescription and medication is the identification of evidence-based treatment and the correspondence of prescription and evidence. Due to the patient’s condition, course of disease and physical differences in different clinical manifestations, for spastic paralysis of different types of evidence, can not use a single treatment, according to the different types of evidence to choose the appropriate prescription, and according to the condition of the evidence with the addition of subtractions, not only to reduce muscle tension, relieve limb spasm, but also to enable the patient’s physical health status has been improved, the function of internal organs back to normal, and give full play to their own potential to fight disease! It can not only reduce the muscle tension and relieve the spasm of the limbs, but also make the patient’s health condition improve, the function of internal organs return to normal, and give full play to their own potential to resist the disease, which is more conducive to the recovery of the motor function of the paralyzed limbs.