A patient with C5 AIS A SCI reports nocturnal bilateral leg spasms that wake the patient and interfere with transfers. Which should the therapist investigate FIRST?

A patient with C5 AIS A SCI reports nocturnal bilateral leg spasms that wake the patient and interfere with transfers. Which should the therapist investigate FIRST?

• A. Whether the patient has developed a new noxious stimulus below the level of injury, such as a UTI, pressure ulcer, or ingrown toenail
• B. Whether the patient's diet has changed recently
• C. Whether the patient has been performing too many push-up pressure reliefs
• D. Whether the patient needs a new wheelchair cushion

Answer: (A)

When a person with spinal cord injury develops new nocturnal leg spasms, the first thing to check is whether there is a new noxious stimulus below the level of injury. Nociceptive input from sources such as a urinary tract infection, a developing pressure ulcer, or a painful ingrown toenail can trigger reflex spasms in someone with a complete injury like C5 AIS A. These triggers are common and addressable, and treating them often reduces or eliminates the spasms, which can improve sleep and, in turn, transfers. So, the therapist should start by assessing for signs of infection or tissue injury below the injury level—check for urinary symptoms and perform a quick UA if indicated, examine skin for breakdown, and inspect the nails for ingrown toenails. If a noxious stimulus is found and addressed, the spasms often lessen. If no stimulus is found, consider other contributors to spasticity or cramping, but the priority is to identify and mitigate any new source of noxious input.

When a person with spinal cord injury develops new nocturnal leg spasms, the first thing to check is whether there is a new noxious stimulus below the level of injury. Nociceptive input from sources such as a urinary tract infection, a developing pressure ulcer, or a painful ingrown toenail can trigger reflex spasms in someone with a complete injury like C5 AIS A. These triggers are common and addressable, and treating them often reduces or eliminates the spasms, which can improve sleep and, in turn, transfers.

So, the therapist should start by assessing for signs of infection or tissue injury below the injury level—check for urinary symptoms and perform a quick UA if indicated, examine skin for breakdown, and inspect the nails for ingrown toenails. If a noxious stimulus is found and addressed, the spasms often lessen. If no stimulus is found, consider other contributors to spasticity or cramping, but the priority is to identify and mitigate any new source of noxious input.