Support Programme for the Assembly of a Database for Spasticity Measurement

A thematic network funded by the European Commission

Spasticity as a clinically relevant phenomenon

Spasticity is a motor disorder associated with upper motor neurone (UMN) lesions, such as stroke, multiple sclerosis and spinal cord injury. It is a phenomenon that can lead to major disability - influencing a patient’s rehabilitation, interfering with function, limiting independence, causing pain and producing secondary complications, such as contractures. One report estimated that the prevalence at one year of spasticity amongst initially hospitalised stroke patients was 38%. It is therefore not surprising that physiotherapy in the rehabilitation of neurologically impaired patients puts great emphasis on the management of spasticity.

Defining spasticity

The most commonly cited definition of spasticity is based on the specific concept of the stretch reflex, which is thought to be hyper-excitable as a consequence of an UMN lesion:

However, in clinical practice, spasticity is often interpreted not as a single component, but as many components. These may include hyper-reflexia, rigidity, resistance to passive movement, etc. So basically the general phrase ‘spasticity’ may involve neural and non-neural components.

So, do we actually know what we are assessing in clinical practice?

Evaluating spasticity

In order to diagnose spasticity and evaluate the efficacy of treatment aimed at reducing it, valid and reliable tools are required. The literature is replete with different methods for the assessment of spasticity, which suggests that interpretations regarding this phenomenon and its underlying processes vary considerably. Also, since the nature of spasticity is multifaceted, it is unlikely that any single measure is able to capture all its manifestations. Instead, a combination of clinical, neurophysiological and biomechanical measures is required to describe symptoms, explain underlying pathological processes and predict the effects of different types of intervention.

The remit of the SPASM consortium

A network of research and clinical centres across Europe has therefore been established to review state of the art in the three major approaches – clinical scales, biomechanical methods, and electrophysiological methods – to measurement of spasticity (and/or its functional consequences). The aim is to then advise best clinical practice.

Due to the complexity in disentangling properties of ‘spasticity’, the Consortium first tried to achieve a broader working definition:

Whether this is more accurate … !

State of the art reviews were presented to a Special Educational Event at the International Society for Physical Rehabilitation and Medicine in Prague 2003. These reviews are currently being completed and will be published in the near future.

Further work planned by the Consortium include:

This project is still in its early stages, and not surprisingly has suggested more questions than answers!

For further details, please visit the website for the project at http://www.ncl.ac.uk/spasm

Duncan Wood, Carol McFadden and Ian Swain