Spasticity Outcome Tools in Traumatic Complete Spinal Cord Injury

Abstract

Objective: To evaluate spasticity in patients of complete motor complete spinal cord injury using M.A.S ,SCATS and PSFS tools of spasticity and assessing their correlation. Design:  Observational cross-sectional study. Setting:  In-patient rehabilitation ward. Participants: 50 individuals of chronic (≥ 1 year trauma) motor complete SCI were classified into mild (n=16), moderate (n=11), and severe (n=23) spastic groups; based on their lower limb extensor muscle group spasticity score using a Modified Ashworth Scale (M.A.S), Spinal cord assessment tool for spastic reflexes(SCATS) and Penn spasm frequency scale (PSFS).  Main Outcome Measures: The proportion of cases in mild, moderate, severe spastic groups, mean MAS score, mean SCATS Score and PSFS Score were evaluated and were compared between the groups with different grades of spasticity. Results:  The mean M.A.S score among the study group was 3.71±1.60. The mean SCAT ankle clonus score, flexor spasm score and extensor spasm score were 1.55±1.05, 1.36±0.81 and 1.22±0.76 respectively (P<0.001S).The mean PSFS (frequency) score and mean PSFS (severity) score was 1.78±0.84 and 1.56±0.70 respectively( P<0.001S). All the three spasticity  outcome tools were found to be significantly associated with the type of spasticity (P≤0.001).A significant positive correlation was observed between M.A.S score and the mean PSFS (FREQ; r = 0.856) score and PSFS (SEV; r = 0.818) score and the mean SCAT score(r=0.913).  Conclusion: All three spasticity outcome tools M.A.S, PSFS and SCATS are acceptable as well as feasible, inherit good clinical utility and correlate significantly with the severity of spasticity. Significant correlations were observed between SCATS score and PSFS score with the M.A.S score. No single outcome measure can reflect the multidimensional nature of spasticity; hence a battery of tests should be applied to measure spasticity to plan antispasmodic treatment in such patients.

Keywords: Spinal cord injury, Spasticity, Modified Ashworth score, Spinal cord assessment tool for spastic reflexes, Penn spasm frequency scale.