Spasticity management in children and adolescents after spinal cord injuries
Abstract
Introduction: Worldwide, the leading causes of death in childhood are injuries and violence. Spinal cord injury (SCI) is a potentially crippling injury which usually results in severe and permanent disability; however, it is relatively rare before the age of 15 years and accounts for only a low proportion of all childhood injuries. SCI and resulting spasticity may cause important loss of functionality. Despite its prevalence, spasticity as a syndrome in SCI patients is not always managed effectively. The aim of this study was to review the management of spasticity in children and adolescents with traumatic SCI. For this reason, a review of the current literature was performed following the PRISMA guidelines and using the online GOOGLE SCHOLAR database and the following keywords: spinal cord injury, pediatric population, spasticity, management of spasticity. Thirty-three studies were finally included in this review. Results: TENS (Transcutaneous Electrical Nerve Stimulation), FES (Functional Electrical Stimulation), muscle activation pattern during movement attempts, spinal manipulative therapy, non invasive brain stimulation, aquatic therapy or hydrotherapy, acupuncture, spinal cord stimulation and intrathecal baclofen therapy, Botulinum toxin A and selective dorsal rhizotomy appear to have a positive effect in reducing spasticity. However, the use of cannabinoids does not appear to have a specific effect on the pediatric population. Transplantation of bone marrow nucleated cells (BMNC) and multiple mesenchymal stem cells (MSC) appear to have an important role in treating SCI patients, however, more clinical trials are required.
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