Outcome measures for SMA

Beyond Nusinersen: Treatment of SMA

Internal Capsule

Modified Ashworth Scale

Trophic changes

On a surface level, trophic changes are simply changes in soft tissue (skin, fascia, muscle), resulting from interruption of nerve supply (Baluk 1992). Neurogenic inflammation is continuing inflammation in the musculoskeletal system, generated by nerve impulses and the release of inflammatory substances from the sensory axon at the site of the original injury. These substances are typically, but not limited to: Substance P (SP), Calcitonic Gene Related Peptide (CGRP), and Neurokinin-A (NKA). Prolonged inflammation and pain can lead to protective muscle spasms, but it more commonly leads to an accumulation of fibrous tissue—which are trophic changes . Devor (1999) stated that the fibrous tissue forms trophic changes, which become palpable taut muscle bands and trigger points; such muscle dysfunction and spasm lead to compression of blood vessels, and decreased blood flow, implicating pain stimulation, and decreased joint mobility. The somatic motor system and the autonomic nervous system influence the skeletal muscular system by stimulating muscles to contract and nerves to secrete during the regulation of molecular organization of other cells, like collagen in soft tissue repair during rehabilitation of an injury. These effects are referred to as trophic, or nutritional, functions of the nervous system (Portenoy, 1994). The key to clinical treatment is to reverse the stimuli that trigger the noxious chemical and mechanical stimuli, which trigger the neurogenic inflammatory response. Manipulation of joints, manual muscle treatments, and interventions that directly target the nervous system like acupuncture and electro-stimulation are key allies in the minimization of trophic changes and the acceleration of soft tissue healing (Lombardi, 2012).