Spasticity is a common motor control disorder frequently encountered in the spectrum of the upper motor neuron (UMN) syndrome. It can result in pain, fatigue, joint restrictions, functional impairments, and skin breakdown that may negatively affect many domains of life by causing social avoidance and diminished life satisfaction. Spasticity is easily identifiable to patients and clinicians, but can be difficult to quantify. There are a variety of tools available to assess spasticity in individuals with spinal cord injury (SCI), including clinical scales and self-reported scales, as well as objective measures for clinical and research use. The goals of spasticity management need to be individualized and set collaboratively with the patients, their caregivers, and the rehabilitation team. Therapeutic rehabilitative interventions are essential to the management of spasticity, both in isolation and in combination with pharmacological and surgical treatment.

The vast majority of individuals with spinal cord injury (SCI) have a neurogenic bladder and significant voiding dysfunctions. Of the various secondary complications following SCI, urinary tract infections are the most common cause of hospitalization post-SCI. This chapter discusses the anatomy and physiology of the upper and lower urinary tracts followed by the comprehensive evaluation of voiding dysfunction. It explains in detail the prophylactic antibiotics for urological procedures and the classification of voiding dysfunction. The chapter also discusses the follow-up/long-term urological surveillance and the incontinence due to the bladder followed by the therapy recommendations for incontinence and retention. It presents the pediatric considerations of neurogenic bladder management, sexuality considerations and the complications of urinary tract following SCI. There is a significant risk of upper and lower urinary tract complications following SCI. However, effective management strategies are available to minimize these risks. Careful urological evaluation, urological surveillance, and management are important.

Spinal cord injury (SCI) remains one of the most devastating injuries any individual can sustain. The ability to predict outcome following SCI is extremely important not only for persons who sustain a traumatic injury and their families, but also for the rehabilitation professionals charged with developing an appropriate plan of care and the researchers investigating the role of natural recovery in future therapeutic investigations. Accurate prognostication following SCI will determine the treatment plan and minimize unnecessary interventions while justifying needed care and resources. This chapter reviews the various factors that impact the performance of an accurate neurological assessment. It describes the extent and time frame of natural recovery following traumatic SCI and clarifies the prospect for specific outcomes such as ambulation. The chapter summarizes the role of traditional imaging and new modalities of viewing the injured spinal cord. It concludes with a brief overview of the underlying mechanisms of recovery.

Spinal neoplasms represent 15% of central nervous system tumors and are classified as either extradural or intradural. Intradural neoplasms are further divided into those that are intramedullary, arising from the substance of the spinal cord, or extramedullary, arising from elements extrinsic to the spinal cord. This chapter categorizes spinal tumors into groups based on the region of the spinal canal they initially involve: intradural intramedullary tumors; intradural extramedullary tumors; and extradural tumors. Surgical is feasible and preferable for the treatment of most spinal tumors. The postoperative functional outcome is closely correlated to the severity of preoperative deficits; therefore, an early diagnosis markedly influences the functional prognosis, and surgical candidates must be carefully selected. The significant advances in spine surgery as well as adjuvant therapies will continue to improve the quality of life and prolong the life span of patients with spinal tumors.

In various disorders of the spinal cord, it may be important to obtain objective information regarding the neurophysiological function of the spinal tracts. Electrodiagnostic assessments have implications for both the diagnosis and prognosis of an individual following spinal cord injury. The sensory (ascending tracts) and the motor (descending tracts) can each be evaluated electrodiagnostically with somatosensory-evoked potentials (SEPs) and motor evoked potentials (MEPs), respectively. Differing from SEPs, MEPs may be elicited by either cortical electrical or magnetic stimulation. Due to the higher, and often painful, electrical stimulus needed to elicit MEPs compared to SEPs, magnetic stimulation has gained in popularity. Finally, MEPs can be useful in the follow up of motor function during treatment and rehabilitation, which may serve of interest for the therapeutic staff and the patient's motivation.

Cardiovascular function is altered in individuals with spinal cord injury (SCI). In cervical and high thoracic injuries in particular, interruption to the sympathetic outflow plays a key role in cardiovascular dysfunction. Loss of supraspinal regulatory control of the sympathetic nervous system results in reduced overall sympathetic activity below the level of injury and causes problems such as hypotension, bradycardia, and a blunted cardiovascular response to exercise. This chapter summarizes the major manifestations of cardiovascular issues after SCI. It is important to be aware of the risk factors and prevention strategies for coronary heart disease (CHD), and to be familiar with unique issues in the diagnosis and management of CHD in patients with SCI. The principles of management of CHD in SCI are essentially the same as for those in the general population as are those for secondary prevention in those with known cardiovascular disease.

Chronic disease and injury often result in difficulties in performing day-to-day activities because of physical, cognitive, or emotional impairments. In rehabilitation clinical practice and research, the process of determining the type and degree of such problems, or the ability to perform normal acts, activities, and roles is typically designated "functional assessment" (FA). The aim of FA is to measure the degree a person's functioning deviates from "normal", where normal may refer to typical functioning for persons without disabilities (either all persons, or persons of the same age, gender, education, etc.), or deviation from the person's own preinjury status. This chapter provides an overview of the concepts and techniques useful in evaluating FA instruments and of the issues involved in selecting instruments for clinical and research applications in spinal cord injury. It presents an overview of available measures, as are references to systematic reviews that discuss the various available FA measures.

Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in the United States. Decompressive surgery for CSM can stabilize or sometimes improve its disabling symptoms there is controversy surrounding the choice of approach: ventral (anterior) versus dorsal (posterior). Surgical decompression of the spinal cord and fusion of the spinal column can arrest the progression of this pathological condition and can sometimes permit recovery of spinal cord function. Additionally, many patients with mild CSM symptoms are treated expectantly. In contrast to CSM, thoracic spinal stenosis (TSS) causing myelopathy is rarer, requires a high index of suspicion for diagnosis, and is typically approached with decompressive laminectomy. As the use of MRI has increased, it is apparent that TSS may be more prevalent than previously appreciated and studies on the ideal treatment for TSS may be necessary in the near future.

Acute cervical spinal cord injury (SCI) management and surgical decision making involves consideration of several key factors, including the patient's age, level or location of injury, mechanism of injury, injury type including bone or discoligamentous involvement, and neurological function. Cervical SCI is most common either among younger males injuring the subaxial spine secondary to accidents or among those of adults over 65 sustaining injury to C2 secondary to ground-level falls. The decision for operative versus nonoperative management depends on the stability of the spine as well as the presence or absence of dislocated fracture or discoligamentous injury. When planning management through traction or when planning an operative approach, the patient's existing medical comorbidities, preoperative neurological deficits, and potential risk of neurological and possibly systemic deterioration must be considered and discussed in order to manage patient and team expectations.