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Arch Phys Med Rehabil. 2018 Aug;99(8):1681-1687. doi: 10.1016/j.apmr.2018.01.017. Epub 2018 Feb 8.

Optimizing the Management of Spasticity in People With Spinal Cord Damage: A Clinical Care Pathway for Assessment and Treatment Decision Making From the Ability Network, an International Initiative.

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Northern Colorado Rehabilitation Hospital, Johnstown, CO, Australia. Electronic address:
Spinal Rehabilitation Service, Caulfield Hospital, Alfred Health, Caulfield, Victoria, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Epworth-Monash Rehabilitation Medicine Unit, Southern Medical School, Monash University, Clayton, Victoria, Australia; Rehabilitation and Aged Care Service, Kingston Centre, Monash Health, Cheltenham, VIC, Australia.
Division of Physiatry, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Shepherd Center, Atlanta, GA, Spain.
Institut Guttmann, Neurorehabilitation Hospital, Autonomous University of Barcelona, Barcelona, Spain.
Department of Physical Medicine and Rehabilitation, R. Poincaré Hospital, AP-HP, University of Versailles Saint Quentin, Garches, France.
Shepherd Center, Atlanta, GA.


The recognition, evaluation, and management of disabling spasticity in persons with spinal cord damage (SCD) is a challenge for health care professionals, institutions, health systems, and patients. To guide the assessment and management of disabling spasticity in individuals with SCD, the Ability Network, an international panel of clinical experts, developed a clinical care pathway. The aim of this pathway is to facilitate treatment decisions that take into account the effect of disabling spasticity on health status, individual preferences and treatment goals, tolerance for adverse events, and burden on caregivers. The pathway emphasizes a patient-centered, individualized approach and the need for interdisciplinary coordination of care, patient involvement in goal setting, and the use of assessment and outcome measures that lend themselves to practical application in the clinic. The clinical care pathway is intended for use by health care professionals who provide care for persons with SCD and disabling spasticity in various settings. Barriers to optimal spasticity management in these people are also discussed. There is an urgent need for the clinical community to clarify and overcome barriers (knowledge-based, organizational, health system) to optimizing the management of spasticity in people with SCD.


Muscle spasticity; Rehabilitation; Spinal cord diseases; Spinal cord injuries


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