**3.4 Phase IV**

One to 12 months post-injury, spasticity and hyperreflexia usually set in, characteristic of **Phase IV**. The remaining DTRs not extinguished during **Phase III** of SS should become absent during this period [3]. Minimal stimuli will elicit cutaneous reflexes, Babinski sign, and DTRs. It has been estimated that there will be detrusor paralysis recovery by 4–6 weeks [3]. The autonomic dysreflexia described in Phase III can also develop during Phase IV, including malignant hypertension, and following its emergence can become chronic/protracted.
