Spasticity: Clinical perceptions, neurological realities and meaningful measurement

Pandyan, Anand; Gregorič, M; Barnes, Michael P.; Wood, Duncan; Wijck, Frederike van; Burridge, Jane; Hermens, Hermanus J.; Johnson, Garth

doi:10.1080/09638280400014576

Cited by 603 publications

(398 citation statements)

References 25 publications

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“…For that reason, different broader definitions are used increasingly. [2][3][4] In this study, a definition introduced by the SPASM consortium 5 is used. The definition describes spasticity as disordered sensorimotor control, presenting as involuntary muscle activation following an upper motor neuron lesion, thus it includes all positive features of upper motor neuron syndrome.…”

Section: Introductionmentioning

confidence: 99%

Perception of lower limb spasticity in patients with spinal cord injury

et al. 2008

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Study design: Cross-sectional study. Objective: To study the manifestation of spasticity in daily life of the patients with spinal cord injury, their perception of spasticity and spasticity-related discomfort. Setting: Rehabilitation center in the Netherlands. Methods: Twenty-six patients with motor complete spinal cord injury (SCI) and spasticity in the lower limbs completed a questionnaire. The following outcome measures were used: manifestation of spasticity, activities during which spasticity occurs, perceived degree of spasticity and resulting discomfort, measured with visual analog scale (VAS) and Borg scale, respectively. Results: In general, spasticity manifested as extensor spasms (84.6%), flexor spasms and/or clonus (both 69.2%), and less often as continuous tension (57.7%). The registered activities were categorized into five main groups: 'changing position' was the largest group (22.0%) with a median VAS of 6.8 (range: 2.5-9.5) and median Borg scale of 3.0 (range: 1.0-7.0). Other groups of activities were 'making a transfer' (20.7%), 'activities of daily living' (17.1%), 'being active' (17.1%) and 'stable body position' (12.2%). The overall correlation between VAS and Borg was moderate (Spearman's rho ¼ 0.53, P ¼ 0.005). Conclusions: Patients with complete SCI experienced several manifestations of spasticity, extensor spasms being the most common. Many daily life activities elicited different manifestations of spasticity. The experienced discomfort was only moderately related to the perceived degree of spasticity during an activity. Possibly, the discomfort is influenced by other factors than the perceived spasticity alone.

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Section: Introductionmentioning

confidence: 99%

Perception of lower limb spasticity in patients with spinal cord injury

et al. 2008

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“…1 The literature has shown that 65-78% of individuals with chronic spinal cord injury (SCI) have symptoms of spasticity. 2,3 It has the potential to negatively influence the quality of life through restricting activities of daily living, causing pain and contributing to the development of contractures.…”

Section: Introductionmentioning

confidence: 99%

Functional hindrance due to spasticity in individuals with spinal cord injury during inpatient rehabilitation and 1 year thereafter

et al. 2015

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Study design: Prospective cohort study. Objective: To assess functional hindrance due to spasticity during inpatient rehabilitation and 1 year thereafter in individuals with spinal cord injury (SCI) and to determine factors that influence the hindrance. Setting: Eight specialized rehabilitation centres in the Netherlands. Methods: A total of 203 patients with recent SCI rated the hindrance they perceived due to spasticity in daily living at the start of active rehabilitation (t1), 3 months later (t2), at discharge (t3) and 1 year after discharge (t4). Hindrance was dichotomized into absent or negligible and present. Multilevel regression analyses were performed to determine the course of functional hindrance due to spasticity and its associations with possible determinants-namely, age, gender, cause, lesion level, motor completeness, spasticity and anti-spasticity medication. Results: The percentage of individuals that indicated functional hindrance due to spasticity ranged from 54 to 62% over time and did not change significantly over time (Δt3t1 odds ratio (OR) = 0.85, P = 0.44; Δt3t2 OR = 1.20, P = 0.41; Δt3t4 OR = 0.91, P = 0.67). The percentage of individuals who experienced a lot of hindrance due to spasticity during specific activities ranged from 4 to 27%. The odds for experiencing functional hindrance due to spasticity were significantly higher for individuals with tetraplegia (OR = 2.17, P = 0.0001), more severe spasticity (OR = 5.51, Po0.0001) and for those using anti-spasticity medication (OR = 4.18, Po0.0001). INTRODUCTIONSpasticity is defined as 'disordered sensori-motor control, resulting from an upper motor neuron lesion, presenting as intermittent or sustained involuntary activation of muscles'. 1 The literature has shown that 65-78% of individuals with chronic spinal cord injury (SCI) have symptoms of spasticity. 2,3 It has the potential to negatively influence the quality of life through restricting activities of daily living, causing pain and contributing to the development of contractures. 4,5 In a sample of SCI survivors, the prevalence of problematic spasticity at 1, 3 and 5 years following SCI was 35%, 31% and 27%, respectively. 5 These findings agree with the observations of Levi et al. 6 and Sköld et al. 3 Adriaansen et al. 7 reported problematic spasticity in 28-34% of individuals with SCI 1-5 years after discharge from inpatient rehabilitation. However, these studies do not describe how hindrance due to spasticity develops in the early phase after SCI. More knowledge is necessary about the course of hindrance over time and which activities of daily living are most hindered by spasticity in order to improve the management of spasticity.The aim of the present study was to describe functional hindrance due to spasticity during inpatient rehabilitation and 1 year thereafter

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“…This definition has the benefit of being precise but has been challenged 5 and does not reflect the multidimensional nature of spasticity. For the purpose of this study, we used a relatively broader definition developed by the SPASM consortium: 6 'Disordered sensory-motor control resulting from an upper motor-neuron lesion presenting intermittent or sustained involuntary activity of muscles'. The definition distinguishes spasticity from the passive viscoelastic changes of muscle properties such as contractures, which are also associated with SCI.…”

Section: Introductionmentioning

confidence: 99%

Modified Ashworth scale and spasm frequency score in spinal cord injury: reliability and correlation

2016

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Study design: Intra-and inter-rater reliability study. Objectives: To assess intra-and inter-rater reliability of the Modified Ashworth Scale (MAS) and Spasm Frequency Score (SFS) in lower extremities in a population of spinal cord-injured persons, as well as correlations between the two scales. Setting: Clinic for Spinal Cord Injuries, Rigshospitalet, Hornbaek, Denmark. Methods: Thirty-one persons participated in the study and were tested four times in total with MAS and SFS by three experienced raters. Cohen's kappa (κ), simple and quadratic weighted (nominal and ordinal scale level of measurement), was used as a measure of reliability and Spearman's rank correlation coefficient for correlation between MAS and SFS. Results: Neurological level ranged from C2 to L2 and American Spinal Injury Association impairment scale A to D. Time since injury was (mean ± s.d.) 3.4 ± 6.5 years. Age was 48.3 ± 20.2 years. Cause of injury was traumatic in 55% and non-traumatic for 45% of the participants. Antispastic medication was used by 61%. MAS showed intra-rater κ simple = − 0.11 to 0.46 and κ weighted = − 0.11 to 0.83. Inter-rater κ simple = − 0.06 to 0.32 and κ weighted = 0.08 to 0.74. SFS showed intra-rater κ weighted = 0.94 and inter-rater κ weighted = 0.93. Correlation between MAS and SFS showed non-significant correlation coefficients from − 0.11 to 0.90. Conclusion: Reliability of MAS is highly affected by the weighting scheme. With a weighted-κ it was overall reliable and simple-κ overall unreliability. Repeated tests should always be performed by the same rater and in a very standardized manner. SFS was found reliable. MAS and SFS are poorly correlated, and ratings were inversely distributed and suggest that it assesses different aspects of spasticity.

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Spasticity: Clinical perceptions, neurological realities and meaningful measurement

Cited by 603 publications

References 25 publications

Perception of lower limb spasticity in patients with spinal cord injury

Perception of lower limb spasticity in patients with spinal cord injury

Functional hindrance due to spasticity in individuals with spinal cord injury during inpatient rehabilitation and 1 year thereafter

Modified Ashworth scale and spasm frequency score in spinal cord injury: reliability and correlation

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