title: Revisiting physiologic and psychologic triggers that increase spasticity.
abstract: OBJECTIVE
  The aims of this study were to systematically identify and summarize the literature examining the impact of physiologic and psychologic triggers on spasticity and discuss the evidence supporting various types of triggers.
  
  
  METHODS
  PubMed, EMBASE, CINAHL, and PEDro databases were searched using specific keyword combinations. Only studies using clinical tests or self-reports of spasticity were included.
  
  
  RESULTS
  A total of 1152 articles were scanned for relevance, and of 44 relevant articles, 24 were reviewed. Pregnancy, posture, cold, circadian rhythm, and skin conditions increased spasticity and were measured using objective clinical tests. Self-reports of spasticity suggest that triggers such as bowel- and bladder-related issues, menstrual cycle, mental stress, and tight clothing can all increase spasticity. No literature evidence of increase in spasticity in response to heterotopic ossification, hemorrhoids, deep vein thrombosis, fever, and sleep patterns was found.
  
  
  CONCLUSIONS
  Although self-reports indicate a strong possibility of increasing spasticity, without objective examination, the true effects of these triggers on spasticity remain inconclusive. Most studies reviewed here were performed in the spinal cord injury population; therefore, it is not known whether these triggers induce similar effects in persons with other neurologic etiologies.
authors.affiliation: Upper Motorneuron Spasticity Research Program, West Park Healthcare Centre, Toronto, Canada.
authors.forename: Chetan P
authors.initials: CP
authors.lastname: Phadke
authors.forename: Chitralakshmi K
authors.initials: CK
authors.lastname: Balasubramanian
authors.forename: Farooq
authors.initials: F
authors.lastname: Ismail
authors.forename: Chris
authors.initials: C
authors.lastname: Boulias
mesh_terms: D002940:Circadian Rhythm; D003080:Cold Temperature; D005260:Female; D006801:Humans; D008598:Menstruation; D009128:Muscle Spasticity / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology*; D011247:Pregnancy; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000503:physiopathology / Q000523:psychology; D013315:Stress, Psychological