Spasticity Workup

Updated: Mar 01, 2018
  • Author: Krupa Pandey, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Workup

Approach Considerations

As previously stated, in patients with new onset spasticity, a thorough history and physical examination, as well as examination using electromyography, a determination of nerve conduction velocities, or imaging studies of the head, neck, and spine may be useful in eliminating treatable causes of increased tone. [2]

Radiographs are especially important in the insensate patient with spinal cord injury (SCI) or the cognitively impaired patient with traumatic brain injury (TBI) if occult fractures are present. Radiography can provide evidence of bowel impaction as well.

Laboratory studies (eg, complete blood count [CBC] and culturing of urine, blood, cerebrospinal fluid) may help to rule out infection.

Spasticity is difficult to quantify, [3] but clinically useful scales include the following:

  • Ashworth Scale/Modified Ashworth: From 0-4 (normal to rigid tone)

  • Physician's Rating Scale: Gait pattern and range of motion assessed

  • Spasm Scale: From 0-4 (no spasms to >10/h)

Functional scales such as the Functional Independence Measure or Gross Motor Function Measure also may be valuable, although they do not measure spasticity directly.

Research-oriented tools for measurement include the following:

  • Tardieu Scale

  • Surface electromyography

  • Isokinetic dynamometry

  • H reflex

  • Tonic vibration reflex

  • F-wave response

  • Flexor reflex response

  • Transcranial electrical/magnetic stimulation