Energy Costs of Spasticity in Spinal Cord Injury: A Pilot Investigation
|Basal Energy Expenditure Spasticity||Other: Weaning of Antispasticity Medication|
|Study Design:||Intervention Model: Single Group Assignment
Masking: Open Label
|Official Title:||Energy Costs of Spasticity in Spinal Cord Injury: A Pilot Investigation|
- Increase in Basal Energy Expenditure [ Time Frame: 7 days ]
|Study Start Date:||January 2008|
|Study Completion Date:||July 2010|
|Primary Completion Date:||July 2010 (Final data collection date for primary outcome measure)|
Weaning of Spasticity Medication over a three day period while measuring Modified Ashworth Scale and Penn Spasm Frequency Score. Then titration of medication back to previous dose over a three day period.
Other: Weaning of Antispasticity Medication
Weaning of antispasticity medication over a three day period and then titration back to previous dose over a three day period.
Obesity is at epidemic proportions in the population with spinal cord injury (SCI), and is likely the mediator of the metabolic syndrome in this special population. Recent literature reviews have suggested that obesity is present in > 67% of persons with SCI. Additionally, recent studies have demonstrated the causal relationship between adipose tissue accumulation and vascular inflammation, dyslipidemia, insulin resistance / glucose intolerance, hypertension and thromboemboli.
Obesity in SCI occurs because of acute and ongoing positive energy balance, i.e., greater caloric intake than energy expenditure. Total Daily Energy Expenditure (TDEE) in SCI is reduced primarily because of muscular atrophy and diminished muscular contraction; pharmacological treatment of spasticity possibly reduces energy expenditure (EE) even further, but has not been evaluated to date. TDEE is comprised of three components: Basal Energy Expenditure (BEE), Thermic Effect of Activity (TEA) and Thermic Effect of Food (TEF). Of the three, BEE contributes the greatest amount (65-75% TDEE) and is the most sensitive to changes in spasticity.
Dampening spasticity has been reported to increase weight gain and necessitate reduced caloric intake in a child with spastic quadriplegia. Similarly, athetosis in patients with cerebral palsy increased resting metabolic rate (RMR) as compared to control subjects with no athetotic movements. Although several studies have reported energy requirements for persons with neurodevelopmental disabilities, and even SCI, however, none have attempted to measure the metabolic effect of spasticity.
Please refer to this study by its ClinicalTrials.gov identifier: NCT00572845
|United States, Virginia|
|McGuire VA Medical Center|
|Richmond, Virginia, United States, 23249|
|Principal Investigator:||David R Gater, MD, PhD||McGuire VA Medical Center|
|Study Chair:||David X Cifu, MD||VCU Department of Physical Medicine and Rehabilitation|