Evaluation of spasticity in adults

Abstract

Spasticity is one component of the upper motor neuron syndrome, which also includes motor deficits and loss of fine movement. Of these three components of the upper motor neuron syndrome, only spasticity is amenable to treatment, hence, the interest in this symptom. Evaluation of spasticity must therefore consider the patient as a whole. The patient presents a disorder of somatic motility that must be described precisely. Clinical examination must identify signs suggestive of spasticity such as alteration of passive mobilization of the limb segment, and abnormal deep tendon reflexes. Electrophysiology may help to define and quantify the altered reflexes. The most important step then consists of demonstrating that the spasticity, its consequences, or both, interfere with the patient's natural movement (or with the patient's remaining functional possibilities when voluntary movement is totally abolished), an essential prerequisite to determining a treatment program. Reversible tests (motor blocks, intrathecal baclofen test injections) provide a major contribution to the determination of functional impairment caused by spasticity and allow the objectives of treatment to be clearly defined. © 2005 Elsevier Inc. All rights reserved.