Item – Theses Canada

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OCLC number
749083402
Link(s) to full text
LAC copy
LAC copy
Author
Adams, Melanie M.
Title
Assessment and activity-based management of spasticity after spinal cord injury.
Degree
Ph. D. -- McMaster University, 2008
Publisher
Ottawa : Library and Archives Canada = Bibliothèque et Archives Canada, [2010]
Description
2 microfiches
Notes
Includes bibliographical references.
Abstract
<?Pub Inc> Sixty-five to 78% of sample populations of individuals with chronic spinal cord injury (SCI) have symptoms of spasticity, but current assessment tools and management strategies are inadequate. Therefore, the purpose of this thesis was to: (1) conduct a review of the definition, pathophysiology, and management of symptoms of spasticity in individuals with SCI, (2) develop and assess a new self-report scale designed to measure the impact of spasticity on daily life in people with SCI, and (3) examine the effects of body-weight supported treadmill training (BWSTT) and tilt-table standing (TTS) on spasticity outcomes. (1) Spasticity was found to be a relevant concern for the SCI population and possibly responsive to activity-based intervention. A need was identified, however, for an assessment tool that allows individuals with SCI to report the impact of their spasticity. (2) In total, 89 individuals with chronic SCI participated in three phases of scale design: development, pilot testing, and evaluation of test-retest reliability and construct validity. The Spinal Cord Injury Spasticity Evaluation Tool (SCI-SET) was developed as a 7-day recall self-report questionnaire that takes into account both the problematic and useful effects of spasticity. The internal consistency ([alpha]) and intraclass correlation coefficient of the SCI-SET were 0.90 and 0.91, respectively. Construct validity was supported by correlations (r=-0.48 to 0.68; p validity was supported by correlations (r=-0.48 to 0.68; p<0.01) between SCI-SET scores and theoretically meaningful constructs (spasticity impact and severity, spasm rating, quality of life, and functional mobility). (3) Seven individuals with chronic SCI performed thrice-weekly BWSTT for 4 wks and thrice-weekly TTS for 4 wks in a random cross-over design and were assessed for changes in symptoms of spasticity immediately following the first session and 24-48 hrs following the twelfth session of activity. Compared to a single session of TTS, moderate and strong effect sizes (ES) supported the tendency of BWSTT to have greater beneficial effects on muscle tone (ES=0.69), flexor spasms (ES=0.57), and motor neuron excitability (ES=0.50). A single session of TTS appeared to reduce extensor spasms (ES=0.68). Flexor spasms (ES=0.79), clonus (ES=0.66), and self-reported mobility (ES=1.27) tended to benefit more from 4 wks of BWSTT than of TTS, whereas extensor spasms had greater reductions following TTS (ES=1.32). Participation in BWSTT appeared to have a favourable effect on quality of life (ES=0.50). In conclusion, the SCI-SET fills a need for a reliable and valid self-report measure of the impact of spasticity on daily life in people with SCI. Individuals with SCI and spasticity may benefit from participation in weight-bearing activity, but the effects of intervention may differ depending on the spasticity outcome and the timeline.
ISBN
9780494578162
0494578165