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Arch Phys Med Rehabil. 2016 Dec;97(12):2222-2228. doi: 10.1016/j.apmr.2016.04.025. Epub 2016 Jun 7.

Optimizing the Management of Disabling Spasticity Following Spinal Cord Damage: The Ability Network-An International Initiative.

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Division of Physiatry, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Brain and Spinal Cord Rehabilitation Program, University Health Network-Toronto Rehabilitation Institute, Toronto, Ontario, Canada. Electronic address:
Northern Colorado Rehabilitation Hospital, Johnstown, CO.
Brain Injury Rehabilitation Department, University Rehabilitation Institute, Ljubljana, Slovenia.
Spinal Rehabilitation Services, Department of Rehabilitation, Caulfield Hospital, Alfred Health, Melbourne, Victoria, Australia; Epworth-Monash Rehabilitation Medicine Unit, Southern Medical School, Monash University, Melbourne, Victoria, Australia.
Department of Physical Medicine and Rehabilitation, R. Poincaré Hospital, Assistance publique - Hôpitaux de Paris, University of Versailles Saint Quentin, Garches, France.
Department of Rehabilitation Medicine, Linköping University, Linköping, Sweden; Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
Roessingh Center for Rehabilitation, Enschede, The Netherlands; Roessingh Research and Development, Enschede, The Netherlands.


Optimizing the treatment of disabling spasticity in persons with spinal cord damage is hampered by a lack of consensus regarding the use of acceptable definitions of spasticity and disabling spasticity, and the relative absence of decision tools such as clinical guidelines and concise algorithms to support decision-making within the broader clinical community. Many people with spinal cord damage are managed outside specialist centers, and variations in practice result in unequal access to best practice despite equal need. In order to address these issues, the Ability Network-an international panel of clinical experts-was initiated to develop management algorithms to guide and standardize the assessment, treatment, and evaluation of outcomes of persons with spinal cord damage and disabling spasticity. To achieve this, consensus was sought on common definitions through facilitated, in-person meetings. To guide patient selection, an in-depth review of the available tools was performed and expert consensus sought to develop an appropriate instrument. Literature reviews are guiding the selection and development of tools to evaluate treatment outcomes (body functions, activity, participation, quality of life) as perceived by people with spinal cord damage and disabling spasticity, and their caregivers and clinicians. Using this approach, the Ability Network aims to facilitate treatment decisions that take into account the following: the impact of disabling spasticity on health status, patient preferences, treatment goals, tolerance for adverse events, and in cases of totally dependent persons, caregiver burden.


Disability evaluation; Guideline; Muscle spasticity; Rehabilitation; Spinal cord diseases; Spinal cord injuries

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