Treatment of Spasticity as Part of Comprehensive Rehabilitation Program for Children with Spinal Cord Injuries

BACKGROUND: Spinal cord injury is a pressing healthcare concern. The quality of life for 60%–78% of patients declines when spastic pain develops, and they require comprehensive treatment.

AIM: The study aimed to evaluate spastic pain treatment as part of a comprehensive rehabilitation program for children with spinal cord injury sequelae.

METHODS: The study included 23 children aged ≥ 10 years to ≤ 17 years with spinal cord injury sequelae, who were admitted to the Clinical and Research Institute of Emergency Pediatric Surgery and Traumatology. The local rehabilitation program lasted 6 months and was divided into three phases: early (3 days to 4 months), intermediate (1 to 3 months), and recovery (after 3 months). The American Spinal Injury Association Impairment Scale was used to evaluate neurological deficits in spinal cord injury. The Ashworth and Tardieu scales, as well as the Pendulum Test, were used to assess spasticity. The Modified Rankin Scale was used to evaluate muscle strength. The Spinal Cord Independence Measure, Version III, was used to evaluate functional independence measure in performing everyday activities. The State-Trait Anxiety Inventory, the Beck Depression Inventory, and the Hospital Anxiety and Depression Scale were used to evaluate the psychoemotional status of patients. The pain severity was assessed using a visual analog pain scale for children aged ≥ 8 years.

RESULTS: A comprehensive rehabilitation program produced reliable positive clinical outcomes for most patients with varying degrees of spasticity. The program included personalized positioning and orthotic regimens, nutritional support, pharmacological support with antispasmodics, analgesics, and adjuvants, preformed physical factors, advanced training with gradual increases in motor load, robotic-assisted locomotor training, and psychological support for patients and their families.

CONCLUSION: In recent years, robotic treatment has become a prevalent treatment option for spasticity. Erigo and Lokomat are the most well-known and promising robot-assisted rehabilitation devices. A comprehensive rehabilitation program reliably produces positive clinical results for children with sequelae of spinal cord injuries and spasticity.