Development of a clinical spasticity scale for evaluation of dogs with chronic thoracolumbar spinal cord injury

Melissa J. Lewis Department of Clinical Sciences, College of Veterinary Medicine, and the Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27607.

Search for other papers by Melissa J. Lewis in
Current site
Google Scholar
PubMed
Close
 VMD
and
Natasha J. Olby Department of Clinical Sciences, College of Veterinary Medicine, and the Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27607.

Search for other papers by Natasha J. Olby in
Current site
Google Scholar
PubMed
Close
 Vet MB, PhD

Abstract

OBJECTIVE To develop a spasticity scale for dogs with chronic deficits following severe spinal cord injury (SCI) for use in clinical assessment and outcome measurement in clinical trials.

ANIMALS 20 chronically paralyzed dogs with a persistent lack of hind limb pain perception caused by an acute SCI at least 3 months previously.

PROCEDURES Spasticity was assessed in both hind limbs via tests of muscle tone, clonus, and flexor and extensor spasms adapted from human scales. Measurement of patellar clonus duration and flexor spasm duration and degree was feasible. These components were used to create a canine spasticity scale (CSS; overall score range, 0 to 18). Temporal variation for individual dogs and interrater reliability were evaluated. Gait was quantified with published gait scales, and CSS scores were compared with gait scores and clinical variables. Owners were questioned regarding spasticity observed at home.

RESULTS 20 dogs were enrolled: 18 with no apparent hind limb pain perception and 2 with blunted responses; 5 were ambulatory. Testing was well tolerated, and scores were repeatable between raters. Median overall CSS score was 7 (range, 3 to 11), and flexor spasms were the most prominent finding. Overall CSS score was not associated with age, SCI duration, lesion location, or owner-reported spasticity. Overall CSS score and flexor spasm duration were associated with gait scores.

CONCLUSIONS AND CLINICAL RELEVANCE The CSS could be used to quantify hind limb spasticity in dogs with chronic thoracolumbar SCI and might be a useful outcome measure. Flexor spasms may represent an integral part of stepping in dogs with severe SCI.

Abstract

OBJECTIVE To develop a spasticity scale for dogs with chronic deficits following severe spinal cord injury (SCI) for use in clinical assessment and outcome measurement in clinical trials.

ANIMALS 20 chronically paralyzed dogs with a persistent lack of hind limb pain perception caused by an acute SCI at least 3 months previously.

PROCEDURES Spasticity was assessed in both hind limbs via tests of muscle tone, clonus, and flexor and extensor spasms adapted from human scales. Measurement of patellar clonus duration and flexor spasm duration and degree was feasible. These components were used to create a canine spasticity scale (CSS; overall score range, 0 to 18). Temporal variation for individual dogs and interrater reliability were evaluated. Gait was quantified with published gait scales, and CSS scores were compared with gait scores and clinical variables. Owners were questioned regarding spasticity observed at home.

RESULTS 20 dogs were enrolled: 18 with no apparent hind limb pain perception and 2 with blunted responses; 5 were ambulatory. Testing was well tolerated, and scores were repeatable between raters. Median overall CSS score was 7 (range, 3 to 11), and flexor spasms were the most prominent finding. Overall CSS score was not associated with age, SCI duration, lesion location, or owner-reported spasticity. Overall CSS score and flexor spasm duration were associated with gait scores.

CONCLUSIONS AND CLINICAL RELEVANCE The CSS could be used to quantify hind limb spasticity in dogs with chronic thoracolumbar SCI and might be a useful outcome measure. Flexor spasms may represent an integral part of stepping in dogs with severe SCI.

Supplementary Materials

    • Supplementary Appendix S1 (PDF 646 kb)
    • Supplementary Appendix S2 (PDF 565 kb)
    • Supplementary Appendix S3 (PDF 742 kb)
    • Supplementary Appendix S4 (PDF 596 kb)
    • Supplementary Video S5 (MP4 661 kb)
    • Supplementary Video S6 (MP4 5527 kb)
    • Supplementary Video S7 (MP4 1958 kb)
  • 1. Maynard FM, Karunas RS, Waring WP III. Epidemiology of spasticity following traumatic spinal cord injury. Arch Phys Med Rehabil 1990; 71: 566569.

    • Search Google Scholar
    • Export Citation
  • 2. Sköld C, Levi R, Seiger A. Spasticity after traumatic spinal cord injury: nature, severity and location. Arch Phys Med Rehabil 1999; 80: 15481557.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3. Blauch B. Spinal reflex walking in the dog. Vet Med Small Anim Clin 1977; 72: 169173.

  • 4. Hall PV, Smith JE, Campbell RL, et al. Neurochemical correlates of spasticity. Life Sci 1976; 18: 14671471.

  • 5. McBride WJ, Hall PV, Chernet E, et al. Alterations of amino acid transmitter systems in spinal cords of chronic paraplegic dogs. J Neurochem 1984; 42: 16251631.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6. Lance JW. The control of muscle tone, reflexes and movement: Robert Wartenberg lecture. Neurology 1980; 30: 13031313.

  • 7. D'Amico JM, Condliffe EG, Martins KJ, et al. Recovery of neuronal and network excitability after spinal cord injury and implications for spasticity. Front Integr Neurosci 2014; 8: 36.

    • Search Google Scholar
    • Export Citation
  • 8. Nielsen JB, Crone C, Hultborn H. The spinal pathophysiology of spasticity: from a basic science point of view. Acta Physiol (Oxf) 2007; 189: 171180.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9. Ashworth B. Preliminary trial of carisoprodol in multiple sclerosis. Practitioner 1964; 192: 540542.

  • 10. Benz EN, Hornby TG, Bode RK, et al. A physiologically based clinical measure for spastic reflexes in spinal cord injury. Arch Phys Med Rehabil 2005; 86: 5259.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11. Biering-Sørensen F, Nielsen JB, Klinge K. Spasticity-assessment: a review. Spinal Cord 2006; 44: 708722.

  • 12. Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 1987; 67: 206207.

  • 13. Mishra C, Ganesh GS. Inter-rater reliability of modified modified Ashworth scale in the assessment of plantar flexor muscle spasticity in patients with spinal cord injury. Physiother Res Int 2014; 19: 231237.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14. Hsieh JT, Wolfe DL, Miller WC, et al. Spasticity outcome measures in spinal cord injury: psychometric properties and clinical utility. Spinal Cord 2008; 46: 8695.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15. Adams MM, Martin Ginis KA, Hicks AL. The Spinal Cord Injury Spasticity Evaluation Tool: development and evaluation. Arch Phys Med Rehabil 2007; 88: 11851192.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16. Akman MN, Bengi R, Karatas M, et al. Assessment of spasticity using isokinetic dynamometry in patients with spinal cord injury. Spinal Cord 1999; 37: 638643.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17. Franzoi AC, Castro C, Cardone C. Isokinetic assessment of spasticity in subjects with traumatic spinal cord injury (ASIA A). Spinal Cord 1999; 37: 416420.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18. Grippo A, Carrai R, Hawamdeh Z, et al. Biomechanical and electromyographic assessment of spastic hypertonus in motor complete traumatic spinal cord-injured individuals. Spinal Cord 2011; 49: 142148.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19. Lechner HE, Frotzler A, Eser P. Relationship between self-and clinically rated spasticity in spinal cord injury. Arch Phys Med Rehabil 2006; 87: 1519.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20. Penn RD. Intrathecal baclofen for spasticity of spinal origin: seven years of experience. J Neurosurg 1992; 77: 236240.

  • 21. Sköld C. Spasticity in spinal cord injury: self- and clinically rated intrinsic fluctuations and intervention-induced changes. Arch Phys Med Rehabil 2000; 81: 144149.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22. Sehgal N, McGuire JR. Beyond Ashworth. Electrophysiologic quantification of spasticity. Phys Med Rehabil Clin N Am 1998; 9: 949979.

  • 23. Voerman GE, Gregoric M, Hermens HJ. Neurophysiological methods for the assessment of spasticity: the Hoffmann reflex, the tendon reflex and the stretch reflex. Disabil Rehabil 2005; 27: 3368.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24. Priebe MM, Sherwood AM, Thornby JI, et al. Clinical assessment of spasticity in spinal cord injury: a multidimensional problem. Arch Phys Med Rehabil 1996; 77: 713716.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25. Johnson RL, Gerhart KA, McCray J, et al. Secondary conditions following spinal cord injury in a population-based sample. Spinal Cord 1998; 36: 4550.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26. Milinis K, Young CA. Trajectories of Outcome in Neurological Conditions (TONiC) study. Systematic review of the influence of spasticity on quality of life in adults with chronic neurological conditions. Disabil Rehabil 2015; 29: 111.

    • Search Google Scholar
    • Export Citation
  • 27. Noonan VK, Kopec JA, Zhang H, et al. Impact of associated conditions resulting from spinal cord injury on health status and quality of life in people with traumatic central cord syndrome. Arch Phys Med Rehabil 2008; 89: 10741082.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28. Westerkam D, Saunders LL, Krause JS. Associations of spasticity and life satisfaction after spinal cord injury. Spinal Cord 2011; 49: 990994.

  • 29. Cardenas DD, Ditunno JF, Graziani V, et al. Two phase 3, multicenter, randomized, placebo-controlled clinical trials of fampridine-SR for treatment of spasticity in chronic spinal cord injury. Spinal Cord 2014; 52: 7076.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30. Handa Y, Naito A, Watanabe S, et al. Functional recovery of locomotor behavior in the adult spinal dog. Tohoku J Exp Med 1986; 148: 373384.

  • 31. Koopmans GC, Deumens R, Honig WM, et al. The assessment of locomotor function in spinal cord injured rats: the importance of objective analysis of coordination. J Neurotrauma 2005; 22: 214225.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 32. Olby NJ, De Risio L, Munana KR, et al. Development of a functional scoring system in dogs with acute spinal cord injuries. Am J Vet Res 2001; 62: 16241628.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33. Olby NJ, Lim JH, Babb K, et al. Gait scoring in dogs with thoracolumbar spinal cord injuries when walking on a treadmill. BMC Vet Res 2014; 10: 58.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 34. Olby NJ, Muguet-Chanoit AC, Lim JH, et al. A placebo-controlled, prospective, randomized clinical trial of polyethylene glycol and methylprednisolone sodium succinate in dogs with intervertebral disk herniation. J Vet Intern Med 2016; 30: 206214.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 35. Cook KF, Teal CR, Engebretson JC, et al. Development and validation of Patient Reported Impact of Spasticity Measure (PRISM). J Rehabil Res Dev 2007; 44: 363371.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 36. De Lahunta A, Glass E. Upper motor neuron. In: De Lahunta A, Glass E, eds. Veterinary neuroanatomy and clinical neurology. 3rd ed. St Louis: Saunders Elsevier, 2009; 192220.

    • Search Google Scholar
    • Export Citation
  • 37. Dewey CW. Functional and dysfunctional neuroanatomy: the key to lesion localization. In: Dewey CW, ed. A practical guide to canine and feline neurology. 2nd ed. Ames, Iowa: Wiley-Blackwell, 2008; 1752.

    • Search Google Scholar
    • Export Citation
  • 38. King AS. Pyramidal system and extrapyramidal system. In: King AS, ed. Physiological and clinical anatomy of domestic mammals: central nervous system Vol 1. Oxford, England: Oxford University Press, 1987; 141157.

    • Search Google Scholar
    • Export Citation
  • 39. Schieber MH. Chapter 2. Comparative anatomy and physiology of the corticospinal system. Handb Clin Neurol 2007; 82: 1537.

  • 40. Fink KL, Cafferty WB. Reorganization of intact descending motor circuits to replace lost connections after injury. Neurotherapeutics 2016; 13: 370381.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 41. Han Q, Cao C, Ding Y, et al. Plasticity of motor network and function in the absence of corticospinal projection. Exp Neurol 2015; 267: 194208.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 42. de Leon RD, Tamaki H, Hodgson JA, et al. Hindlimb locomotor and postural training modulates glycinergic inhibition in the spinal cord of the adult spinal cat. J Neurophysiol 1999; 82: 359369.

    • Crossref
    • Search Google Scholar
    • Export Citation

Advertisement