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Spasticity is defined as exaggerated muscle tone with increased tendon reflexes. Spasm describes violent reflexive muscle contraction which occurs in response to cutaneous and visceral stimulation.

Spasticity

Associated with SCI above level of T12 which preserves spinal reflex arc

May be exacerbated by bladder, bowels, skin, pain. Identifying and managing exacerbating factor is the first goal of treatment. This followed by physical exercise ( splinting, stretching incl. passive movement, standing) and then medications (Baclofen, Tizanidine, Dantrolene, Clonidine, Diazepam, Botox Injections).

Poor management leads to contractures, pressure ulcers, pain and can impact on function, care needs and quality of life.

Pain post - SCI is commonly divided into neuropathic pain and nociceptive pain.

Nocioceptive which can either be musculoskeletal pain; often described as 'aching' in nature and due to muscle imbalance or visceral pain for example from bladder, bowel, gallbladder.

Neuropathic pain is pain initiated or caused by a primary lesion or dysfunction of the nervous system.

Usually identified as above level of lesion, at level or below level.

Can be exacerbated by another stimulus e.g. an infection

Treatment often empirical with use of nociceptive medications (NSAIDs and opioids) or neuropathic pain medications (e.g. antidepressants and anticonvulsants).

Non-pharmacological treatments include physical therapy (e.g TENs), psychological (coping and distraction), chemical or surgical nerve ablation.

Spasticity is a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks, resulting from hyper-excitability of the stretch reflexes, as one component of the upper motoneuron syndrome

Recent studies indicate that, besides changes in motoneuron activation (involuntary supraspinal descending inputs and inhibited spinal reflexes etc), changes in muscle properties also contribute to the clinical appearance of limb spasticity and rigidity, which are frequently linked symptoms.

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Signs of exaggerated tendon tap reflexes associated with muscle hypertonia are generally thought to be responsible for spastic movement disorders.

Determining the impact of spasticity and need for treatment

Spasticity in SCI varies with location and degree depending on the injury pathophysiology. The goal of treatment should be to reduce pain or discomfort related to spasticity, prevent the breakdown of skin and fractures, and overcome functional impairments related ' to spasticity'.

Endoscopic ultrasound (EUS) combines endoscopy and ultrasound to obtain diagnostic images of the digestive tract and surrounding tissue and organs; in IBD patientsm this method is most often used to examine fistulas in the rectal area.

Much of the small intestine cannot be imaged by endoscopy. Radiology is used for this part of the GI tract:

X-rays can detect blockages in both the small and large intestine. 16

X-rays with barium liquid contrast are used with endoscopy to both monitor and treat IBD.

Computerized tomography scans (CT or CAT) are cross-sectional X-ray images of internal organs from various angles.

Magnetic resonance imaging scans (MRI) use magnetization and radio waves to produce images of the internal organs; MRI technology is used to evaluate perianal fistulas and abscesses in IBD patients.

White blood cell scans detect white blood cell accumulation in inflamed tissue. GI tract inflammation is characteristic of ulcerative colitis and Crohn’s disease. 17

Ultrasonography/ultrasound bounces high-frequency sound waves off internal tissue. Their echoes are converted into images; the technology is sometimes used with other radiological tests to examine the bowel.

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Once a diagnosis has been made, your health care provider can help you establish a regular course of maintenance therapy to help control IBD symptoms, and minimize any potential long-term effects of the disease.

Highly individualized and dependent on the illness type, severity, and resulting symptoms, IBD treatment includes medications, dietary changes, and surgery . Counseling is sometimes recommended because the stress of chronic illness can exacerbate symptoms.

Health care providers work with IBD patients to determine the optimal combination of anti-inflammatory drugs to reduce symptoms, and to help avoid or post-pone surgery . Because the steroids commonly used to treat IBD can cause serious long-term side effects, alternative treatments are constantly being sought.

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IBD medication relieves symptoms, reduces inflammation, and prevents flare-ups. To discover what works best, it may be necessary to try several different treatments and/or combinations of treatments.

~Aminosalicylates~

Mild to moderate IBD is often initially treated with aminosalicylates (antibiotics) . They can minimize bacterial growth in the small intestine caused by bowel narrowing (stricture), fistulas, and/or surgery. Researchers suggest that antibiotics may also help suppress the immune system.

~Immunosuppressants ~

Deliberately induced immunosuppression – to reduce activation of the immune system – is another first line of defense for IBD and other autoimmune diseases. Medications – such as azathioprine (an immunosuppressant), 6-mercaptopurine (an immunosuppressant), methotrexate (an anti-metabolite), prednisone (a corticosteroid), or TNF inhibition (tumor necrosis factor) – work to control symptoms.

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