Scales and tests in the rehabilitation and treatment of patients with spasticity of the lower limbs

Abstract

The problem-oriented approach in the rehabilitation of patients with spasticity requires careful assessment of the situation in the concept of The International Classification of Functioning, Disability and Health (ICF): impairment of the structure, functions and limitation of activity in specific environmental factors. Standardized tools in the assessment of muscle tone allow to get objective data about motor function. The use of the Modified Ashworth scale (MAS) and the Tardieu Scale are discussed. The standardized assessment of independent mobility is an important issue in outcome measuring. The ultimate goal of intervention, including the use of botulinum toxin therapy in the case of spasticity, is to support patient's daily activities. The article presents scales and tests for assessment of mobility: The Hauser Test, the Rivermead Mobility Index and functional assessment walking tests. The authors describe a clinical case of lower limb spasticity treatment with abobotulinumtoxin A and its assessment with these scales.

Spasticity: Diagnosis and Treatment

“…There is also a muscle reaction angle (x): measured as the difference between the forced position of the joint and the angle of the normal anatomical position of the limb and its segments (applies to all joints except the hip) [32,34].…”

“…Considering the treatment of spasticity as part of the rehabilitation process and, given that the therapeutic effect on spasticity has the ultimate goal of normalizing the life and activities of the patient, Graces recommends the following step-by-step strategy for the use of the tardier scale [33]. The place and role of MTS in rehabilitation is demonstrated in the following algorithm of rehabilitation approach to patients with spastic paresis (Figure 26) [34]. It involves testing the patient, identifying the problem, selecting the rehabilitation goal, developing an intervention plan, and then analyzing the outcome with the selection of the new rehabilitation goal.…”

“…The concept of self-service includes not only movement but also its assessment should be supplemented by the analysis of the degree of influence of spasticity in the hand on daily activities. The most convenient and informative tool for this analysis is the Leeds scale of influence of spasticity of the hand on the activity (LASIS) [34,39,40].…”

“…The Hauser Ambulation Index (HAI) includes the ranking of patients by 10 gradations depending on the need for external assistance, the use of devices for movement, and the time of passing the test distance [34,36].…”