Relationship between self- and clinically rated spasticity in spinal cord injury

Abstract

Objectives: To assess the relation between self- and clinically rated spasticity in spinal cord injury (SCI) and to determine the extent to which symptoms like pain are included in the patients' self-rating of spasticity.

Design: Part 1: an observational, prospective, cross-sectional study and part 2: an observational, prospective, longitudinal study.

Setting: Swiss paraplegic center.

Participants: Forty-seven (part 1) and 8 (part 2) persons with spastic SCI (American Spinal Injury Association grade A or B).

Interventions: Not applicable.

Main outcome measures: Clinical rating of movement-provoked spasticity using the Ashworth Scale; self-rating of general and present spasticity by the subject on a 4-point spasm severity scale and by using a visual analog scale (VAS); and questionnaires asking for antispasticity medication, impact of spasticity on daily life, body segment affected by spasticity, and symptoms associated with its occurrence.

Results: There was a poor correlation (rho=.36) between clinically rated (Ashworth Scale) spasticity and self-rated general spasticity and a modest correlation (rho=.70) between Ashworth Scale and self-rated present spasticity in the cross-sectional study in 47 subjects. Questionnaires showed that symptoms like pain and other sensations were associated by the patients with spasticity. There was a significant, but weak, correlation between VAS and Ashworth Scale in the longitudinal study in 3 of the 8 subjects and nonsignificant correlations in the remaining 5 subjects.

Conclusions: A single clinical assessment of spasticity is a poor indication of a patient's general spasticity. Clinical measures of muscle tone-related spasticity should be complemented by self-rating that distinguishes muscle tone-related spasticity from spasticity affecting the sensory nervous system.