Table 2.
Triggers of spasticity
| Triggers | Examples | Recommendations |
|---|---|---|
| Bladder and bowel | UTI | Check urinalysis, C&S |
| Urinary tract calculi | Renal US to evaluate for hydronephrosis or stones | |
| Gallstones | Abdominal x-ray to evaluate stool burden and rule out obstruction | |
| Diverticulitis | Typical sensory signs of abdominal pathology may be absent or nonspecific in SCI; if initial exams (US or x-ray) are inconclusive or you have a high index of suspicion, obtain CT scan of abdomen. | |
| Appendicitis | ||
| Abscess | ||
| Other infection or inflammation | ||
| Constipation | ||
| Skin | Pressure injury | Patient education regarding skin checks, pressure-relieving techniques, hygiene |
| Maceration or skin irritation | Observe transfer technique | |
| Ingrown toenails | Podiatry referral | |
| Tight clothing | MRI if osteomyelitis is suspected | |
| Osteomyelitis | ||
| Pain | Neuropathic pain | Check for organic causes (i.e., other triggers) |
| Nociceptive (musculoskeletal, visceral pain) | Medication adjustment | |
| Pregnancy | Physical and hormonal changes (enlarging uterus, joint laxity) Postpartum | Preconception counselling |
| Education regarding medications during pregnancy | ||
| Referral to therapy for anticipated needs as pregnancy progresses (e.g., wheelchair, transfers, etc.) | ||
| Positioning | Change in position | Orthotic evaluation |
| Ill-fitting orthoses | Wheelchair/seating evaluation | |
| Wheelchair issues | ||
| Temperature | Cold | Appropriate clothing; dress in layers to adjust to changes in temperature and temperature dysregulation |
| Heat | ||
| Mental stress | Anxiety | Consider psychology/psychiatry consult for coping and behavioral strategies |
| Mental stress | ||
| Physical or neurological change | Syringomyelia | MRI of spine with and without contrast to evaluate for syringomyelia or tethered cord |
| Tethered cord | ||
| Fracture | X-rays if warranted | |
| Heterotopic ossification | EMG/NCS | |
| Compression neuropathy | ||
| Systemic illness | Deep venous thrombosis | Obtain doppler ultrasound |
| Systemic infection | Check CBC, CMP |
Note: CBC = complete blood count; CMP = complete metabolic profile ; C&S = culture and sensitivity; EMG/NCS = electromyography/nerve conduction study; US = ultrasound; UTI = urinary tract infection.