Skip to main content
SpringerLink
Log in

Measurement of Spasticity

  • Chapter
Clinical Evaluation and Management of Spasticity

Part of the book series: Current Clinical Neurology ((CCNEU))

  • 268 Accesses

Abstract

Spasticity is generally defined as velocity-dependent increased resistance during passive movement of peripheral joints owing to increased involuntary muscle activity. However, the word spasticity is clinically used to describe a constellation of symptoms that arise secondary to the upper motor neuron (UMN) syndrome associated with a wide variety of neurological conditions. The clinically observed components of spasticity include increased resistance to passive movement, increased phasic-stretch reflexes, clonus, and flexor or extensor spasms (1–3). These features of spasticity clearly can impede functional motor activities. However, the UMN syndrome includes other important components including weakness, co-contraction of agonist and antagonist muscles, the presence of “pattern” movements (mass contraction of groups of muscles across joints when isolated movements are attempted), and lack of fine motor control. These other components of the UMN syndrome usually contribute more to motor impairment than spasticity. Spasticity is actually beneficial in certain situations. For example, increased extensor tone may facilitate standing in some patients. Theoretical benefits of spasticity include maintenance of muscle mass, reduction of edema, decreased risk of deep venous thrombosis (DVT), and prevention of bone demineralization in weakened extremities (1).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Little, J. W. and Massagli, T. L. (1993) Spasticity and associated abnormalities of muscle tone, in Rehabilitation Medicine: Principles and Practice, 2nd ed. ( Delisa, J. A., ed.), JB Lippincott Company, Philadelphia, pp. 666–680.

    Google Scholar 

  2. Young, R. (1994) Spasticity: a review. Neurology 44 (Suppl. 9), S12 — S20.

    PubMed  CAS  Google Scholar 

  3. Dimitrijevic, M. R. (1995) Evaluation and treatment of spasticity. J. Neuro. Rehabil. 9, 97–110.

    Google Scholar 

  4. Rymer, W. Z. and Katz, R. T. (1994) Mechanisms of spastic hypertonia, in Physical Medicine and Rehabilitation: State of the Art Reviews, vol. 8, Hanley Belfus, Inc., Philadelphia, pp. 441–454.

    Google Scholar 

  5. Ashworth, B. (1964) Preliminary trial of carisoprodol in multiple sclerosis. Practitioner 192, 540–542.

    PubMed  CAS  Google Scholar 

  6. Bohannon, R. W. and Smith, M. B. (1987) Interater reliability of a Modified Ashworth Scale of muscle spasticity. Phys. Ther. 67, 206–207.

    PubMed  CAS  Google Scholar 

  7. Lee, K.-C., Carson, L., Kinnin, E., and Patterson, V. (1989) The Ashworth Scale: A reliable and reproducible method of measuring spasticity. J. Neuro. Rehabil. 3, 205–209.

    Google Scholar 

  8. Allison, S. C., Abraham, L. D., and Petersen, C. L. (1996) Reliability of the Modified Ashworth Scale in the assessment of plantarflexor muscle spasticity in patients with traumatic brain injury. Int. J. Rehab. Res. 19, 67–78.

    Article  CAS  Google Scholar 

  9. Sköld, C., Harms-Ringdal, K., Hulting, C. et al. (1998) Simultaneous Ashworth measurements and electromyographic recording in tetraplegic patients. Arch. Phys. Med. Rehabil. 79, 959–965.

    Article  PubMed  Google Scholar 

  10. Penn, R. D. et al. (1989) Intrathecal baclofen for severe spinal spasticity. N. Engl. J. Med. 320, 1517–1521.

    Article  PubMed  CAS  Google Scholar 

  11. Loubser, P. G. et al. (1991) Continuous infusion of intrathecal baclofen: Longterm effects on spasticity in spinal cord injury. Paraplegia 29, 48–64.

    Article  PubMed  CAS  Google Scholar 

  12. Albright, A. L., Cervi, A., and Singletary, J. (1991) Intrathecal baclofen for spasticity in cerebral palsy. JAMA 265, 1418–1422.

    Article  PubMed  CAS  Google Scholar 

  13. Middel, B. et al. (1997) Effect of intrathecal baclofen delivered by an implanted programmable pump on health related quality of life in patients with severe spasticity. J. Neurol. Neurosurg. Psychiatry 63, 204–209.

    Article  PubMed  CAS  Google Scholar 

  14. Goff, B. (1976) Grading of spasticity and its effect on voluntary movement. Physiotherapy 62, 358–361.

    PubMed  CAS  Google Scholar 

  15. Das, T. K. and Park, D. M. (1989) Effect of treatment with botulinum toxin on spasticity. Postgrad. Med. J. 65, 208–210.

    Article  PubMed  CAS  Google Scholar 

  16. Pedersen, E., Klemar, B., and Törring, J. (1979) Counting of flexor spasms. Acta. Neurol. Scand. 60, 164–169.

    Google Scholar 

  17. Rymer, W. Z. and Katz, R. T. (1994) Mechanical quantification of spastic hypertonia, in Physical Medicine and Rehabilitation: State of the Art Reviews, vol. 8, Hanley Belfus, Inc., Philadelphia, pp. 455–463.

    Google Scholar 

  18. Bajd, T. and Vodovnik, L. (1984) Pendulum testing of spasticity. J. Biomed. Eng. 6, 9–16.

    Article  PubMed  CAS  Google Scholar 

  19. Vodovnik, L., Bowman, B. R., and Bajd, T. (1984) Dynamics of spastic knee joint. Med. Biol. Eng. Comput. 22, 63–69.

    Article  PubMed  CAS  Google Scholar 

  20. Lin, D. C. and Rymer, W. Z. (1991) A quantitative analysis of pendular motion of the lower leg in spastic human subjects. IEEE Trans. Biomed. Eng. 38, 906–918.

    Article  PubMed  CAS  Google Scholar 

  21. Franken, H. M. et al. (1993) Identification of passive knee joint and shank dynamics in paraplegics using quadriceps stimulation. IEEE Trans. Biomed. Eng. 1, 154–163.

    Google Scholar 

  22. Fowler, V. et al. (1998) Muscle length effect on the pendulum test. Arch Phys. Med. Rehabil. 79, 169–171.

    Article  PubMed  CAS  Google Scholar 

  23. Kaeser, H. E. et al. (1998) Testing an antispasticity drug (Tetrazepam) with the pendulum test: a monocentric pilot study. J Neuro. Rehabil. 12, 169–177.

    Google Scholar 

  24. Brown, R. A. et al. (1988) Does the Wartenberg pendulum test differentiate quantitatively between spasticity and rigidity? A study in elderly stroke and Parkinsonian patients. J. Neurol. Neurosurg. Psychiatry 51, 1178–1186.

    Article  PubMed  CAS  Google Scholar 

  25. Leslie, G. C. et al. (1992) A comparison of the assessment of spasticity by the Wartenberg pendulum test and the Ashworth grading scale in patients with multiple sclerosis. Clin. Rehabil. 6, 41–48.

    Article  Google Scholar 

  26. Bohannon, R. (1999) Usefulness of the pendulum test. Neurorehab. Neural Repair 13, 259–260.

    Article  Google Scholar 

  27. Simons, D. G. and Lamonte, R. J. (1971) Automated system for the measurement of reflex responses to patellar taps in man. Am. J Phys. Med. 50, 72–79.

    PubMed  CAS  Google Scholar 

  28. Zhang, L.-Q. et al. (1999) System identification of tendon reflex dynamics. IEEE Trans. Biomed. Eng. 7, 193–203.

    Google Scholar 

  29. Stam, J. and Tan, K. M. (1987) Tendon reflex variability and method of stimulation. Electroencephalogr. Clin. Neurophysiol. 67, 463–467.

    Article  PubMed  CAS  Google Scholar 

  30. Meinders, M. et al. (1996) The stretch reflex response in the normal and spastic ankle-effect of ankle position. Arch Phys. Med. Rehabil. 77, 487–492.

    Article  PubMed  CAS  Google Scholar 

  31. Gottlieb, G. L., Agarwal, G. C., and Penn, R. (1978) Sinusoidal oscillation of the ankle as a means of evaluating the spastic patient. J. Neurol. Neurosurg. Psychiatry 41, 32–39.

    Article  PubMed  CAS  Google Scholar 

  32. Myklebust, B. M., Gottlieb, G. L., Penn, R. D., and Agarwal, G. C. (1982) Reciprocal excitation of antagonistic muscles as a differentiating feature in spasticity. Ann Neurol. 12, 367–374.

    Article  PubMed  CAS  Google Scholar 

  33. Lehmann, J. F. et al. (1989) Spasticity: quantitative measurements as a basis for assessing effectiveness of therapeutic intervention. Arch. Phys. Med. Rehabil. 70, 6–15.

    PubMed  CAS  Google Scholar 

  34. Price, R. et al. (1991) Quantitative measurement of spasticity in children with cerebral palsy. Dev. Med. Child Neurol. 33, 585–595.

    Article  PubMed  CAS  Google Scholar 

  35. Zhang, L.-Q., Rymer, W. Z. (1997) Simultaneous and nonlinear identification of mechanical and reflex properties of human elbow joint muscles. IEEE Trans. Biomed. Eng. 44, 1192–1209.

    Article  PubMed  CAS  Google Scholar 

  36. Zhang, L.-Q. et al. (1998) In vivo human knee joint dynamic properties as functions of muscle contraction and joint position. J. Biomech. 31, 71–76.

    CAS  Google Scholar 

  37. Zhang, L.-Q. et al. (1998) Reflex and intrinsic mechanical changes in spastic limbs of MS patients. Proceedings of the 20th Annual International Conference of the IEEE Engineering in Medicine and Biology Society 20, 2321–2324.

    Google Scholar 

  38. Sinkjær, T. and Magnussen, I. (1994) Passive, intrinsic and reflex-mediated stiffness in the ankle extensors of hemiparetic patients. Brain 117, 355–363.

    Article  PubMed  Google Scholar 

  39. Sinkjær, T. et al. (1988) Muscle stiffness in human ankle dorsiflexors: Intrinsic and reflex components. J. Neurophys. 60, 1110–1121.

    Google Scholar 

  40. Sinkjær, T. et al. (1993) Non-reflex and reflex mediated ankle joint stiffness in multiple sclerosis patients with spasticity. Muscle Nerve 16, 69–76.

    Article  PubMed  Google Scholar 

  41. Dietz, V. et al. (1993) Spastic paresis: Reflex activity and muscle tone in elbow muscles during passive and active motor tasks, in Spasticity: Mechanisms and Management ( Thilmann, A. F, et al., eds.), Springer-Verlag, Berlin and Heidelberg, pp. 251–264.

    Chapter  Google Scholar 

  42. Hinderer, S. R. et al. (1990) Spasticity in spinal cord injured persons: quantitative effects of baclofen and placebo treatments. Am. J. Phys. Med. Rehabil. 69, 311–317.

    Article  PubMed  CAS  Google Scholar 

  43. Dimitrijevié, M. R. and Nathan, P. W. (1971) Studies of spasticity in man 5 Dishabituation of the flexion reflex in spinal man. Brain 94, 77–90.

    Article  Google Scholar 

  44. Dimitrijevié, M. R. and Sherwood, A. M. (1980) Spasticity: Medical and surgical treatment. Neurology 30, 19–27.

    Article  Google Scholar 

  45. Keenan, M.-A. E., Haider, T. T., and Stone, L. R. (1990) Dynamic electromyography to assess elbow spasticity. J. Hand Surg. 15A, 607–614.

    Article  CAS  Google Scholar 

  46. Fisher, M. A., Shahani, B. T., and Young, R. R. (1979) Electrophysiologic analysis of the motor system after stroke: The flexor reflex. Arch. Phys. Med. Rehabil. 60, 7–11.

    PubMed  CAS  Google Scholar 

  47. Tarring, J., Pedersen, E., and Klemar, B. (1981) Standardisation of the electrical elicitation of the human flexor reflex. J. Neurol. Neurosurg. Psychiatry 44, 129–132.

    Article  Google Scholar 

  48. Meinck H.-M., Küster, S., Benecke, R., and Conrad, B. (1985) The flexor reflex-influence of stimulus parameters on the reflex response. Electroencephalogr. Clin. Neurophysiol. 61, 287–298.

    Article  PubMed  CAS  Google Scholar 

  49. Bathien, N. and Bourdarias, H. (1972) Lower limb cutaneous reflexes in hemiplegia. Brain 95, 447–456.

    Article  PubMed  CAS  Google Scholar 

  50. Dimitrijevic, M. R. and Nathan, P. W. (1968) Studies of spasticity in man. 3. Analysis of reflex activity evoked by noxious cutaneous stimulation. Brain 91, 349–368.

    Article  PubMed  CAS  Google Scholar 

  51. Dewald J.-P. A. et al. (1995) Abnormal muscle coactivation patterns during isometric torque generation at the elbow and shoulder in hemiparetic subjects. Brain 118, 495–510.

    Article  PubMed  Google Scholar 

  52. Conrad, B., Benecke, R., and Meinck, H.-M. (1985) Gait disturbances in para-spastic patients, in Clinical Neurophysiology in Spasticity ( Delwaide, P. J. and Young, R. R., ed.), Elsevier Science Publishers BV, The Netherlands.

    Google Scholar 

  53. Fung, J. and Barbeau, H. (1989) A dynamic EMG profile index to quantify muscular activation disorder in spastic paretic gait. Electroencephalogr. Clin. Neurophysiol. 73, 233–244.

    Article  PubMed  CAS  Google Scholar 

  54. Sutherland, D. H. (1978) Gait analysis in cerebral palsy. Dey. Med. Child Neurol. 20, 807–813.

    Article  CAS  Google Scholar 

  55. Shapiro, A. et al. (1990) Preoperative and postoperative gait evaluation in cerebral palsy. Arch. Phys. Med. Rehabil. 71, 236–240.

    PubMed  CAS  Google Scholar 

  56. Delwaide, P. J. (1985) Electrophysiological analysis of the mode of action of muscle relaxants in spasticity. Ann. Neurol. 17, 90–95.

    Article  PubMed  CAS  Google Scholar 

  57. Angel, R. W. and Hofmann, W. W. (1963) The H reflex in normal, spastic, and rigid subjects. Arch. Neurol. 8, 591–596.

    Article  Google Scholar 

  58. Matthews, W. B. (1966) Ratio maximum H reflex to maximum M response as a measure of spasticity. J. Neurol. Neurosurg. Psychiatry 29, 201–204.

    Article  PubMed  CAS  Google Scholar 

  59. Yanagisawa, N. et al. (1993) Methodological problems in the Hoffmann reflex study of spasticity, in Spasticity: Mechanisms and Management ( Thilmann, A. F., et al., eds.), Springer-Verlag, Berlin-Heidelberg, pp. 273–286.

    Chapter  Google Scholar 

  60. Little, J. W. and Halar, E. M. (1985) H-reflex changes following spinal cord injury. Arch. Phys. Med. Rehabil. 66, 19–22.

    PubMed  CAS  Google Scholar 

  61. Strassburg, H. M., Oepen, G., and Thoden, U. (1980) The late facilitation in H-reflex recovery cycles in different pyramidal lesions. Arch. Psychiat. Nervenkr. 228, 197–204.

    Article  PubMed  CAS  Google Scholar 

  62. Eisen, A. and Odusote, K. (1979) Amplitude of the F wave: a potential means of documenting spasticity. Neurology 29, 1306–1309.

    Article  PubMed  CAS  Google Scholar 

  63. Mayer, N. H. (1991) Functional management of spasticity after head injury. J. Neuro. Rehabil. 5, S 1 - S4.

    Google Scholar 

  64. Corcos, D. M. et al. (1986) Movement deficits caused by hyperexcitable stretch reflexes in spastic humans. Brain 109, 1043–1058.

    Article  PubMed  Google Scholar 

  65. Mizrahi, E. M. and Angel, R. W. (1979) Impairment of voluntary movement by spasticity. Ann. Neurol. 5, 594–595.

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. David C. Good
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Springfield Clinic Neuroscience Institute, Springfield, IL, USA

    David A. Gelber MD

  2. Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA

    Douglas R. Jeffery MD, PhD

Rights and permissions

Reprints and permissions

Copyright information

© 2002 Springer Science+Business Media New York

About this chapter

Cite this chapter

Good, D.C. (2002). Measurement of Spasticity. In: Gelber, D.A., Jeffery, D.R. (eds) Clinical Evaluation and Management of Spasticity. Current Clinical Neurology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-092-6_3

Download citation

  • DOI: https://doi.org/10.1007/978-1-59259-092-6_3

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-61737-109-7

  • Online ISBN: 978-1-59259-092-6

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation