The clinical assessment of Spasticity involves taking a detailed history and carrying out a comprehensive examination.

Enquire about:

  • Pain or spasms including spasm frequency or severity scores (e.g. Penn Spasm Frequency Scale).
  • Associated restrictions or limitations in function including the impact on:
    • Skin care and cleansing.
    • Dressing difficulties.
    • Seating, transfer and mobility restrictions.
  • Previous treatment measures including physical therapies, seating changes, medication. Note which of these were effective.
  • If the spasticity is new or has changed in pattern, consider potential aggravating factors, including:
    • Changes in pain pattern.
    • Changes in continence.
    • Any new skin lesions.

Examination
a. Baseline neurological examination.
b. Posture – what is the position at rest?
c. Tone can be defined using a combination of The Modified Ashworth Scale and The Joint Range of Movement:

SCORE DESCRIPTION
0 No increase in muscle tone.
1 Slight increase in muscle tone, manifested by a catch and release, or by minimal resistance at the end of the range of motion when the affected part(s) is moved in flexion or extension.
1+ Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the range of movement (ROM).
2 More marked increase in muscle tone through most of ROM, but affected part(s) easily moved.
3 Considerable increase in muscle tone, passive movement difficult.
4 Affected part(s) rigid in flexion and extension.
  • Joint Range of Movement. Use either:
    • Angular measures of the extent to which the range is limited using “neutral” as a descriptor (e.g. elbow extension limited by 30⁰ from neutral, dorsiflexion limited to 15⁰ below neutral).
    • Separation distances (e.g. how closely can finger and palm be approximated; finger-palm distance).

d. Reflexes.
e. Measures of freedom or agility of movement including:

  • Dexterity e.g. nine hole peg test.
  • Gait e.g. timed 10 meter walk.