Diagnosis of Spasticity

Spasticity is a clinical sign characterized by muscle over-activity and high tone spasms that is associated with several distinct neurological diseases. Timely diagnosis and management are essential to prevent contracture of the muscles and soft tissues, which can lead to deformity of the bones and limbs.

Characteristic Signs

There are several signs that are indicative of spasticity, including:

• Increased muscle tone
• Muscle spasms and clonus
• Muscular contraction
• Pain or discomfort
• Postural abnormalities

As a result, patients that suffer from spasticity often experience a reduced ability to function and may have difficulty with simple tasks, such as personal care and hygiene. This can also lead to a significant decrease in quality of life for the individual.

Clinical Assessment

The clinical assessment will typically include a comprehensive medical history followed by an analysis of posture, movement control, muscular strength, coordination, endurance and spasticity. The assessment of spasticity involves the observation of muscular resistant to passive lengthening when it is relaxed. A muscle with spasticity will exhibit heightened resistance to passive stretch when compared other muscles in the body.

The involvement of a multidisciplinary healthcare team may be required in the diagnostic process of spasticity. This may include a physical therapist, physician, neurologist, rehabilitation physician, orthopedic surgeon and an occupational therapist.

It is important that the specific signs and symptoms that the patient is experiencing are discussed, in addition to difficulties that may have presented when partaking in daily activities as a result of the symptoms. This information will also help when the treatment for the condition is initiated.

Other Diagnostic Tests

In some cases, an electromyography may be used to determine specific nerve conduction velocities, which can guide diagnosis.

Additionally, diagnostic imaging techniques may be used to visualize changes to the head, neck and spine and identify possible causes for muscular symptoms. For example, magnetic resonance imaging (MRI) can be used to glean information about the nature of the causative damage to the central nervous system.

Severity Classification and Evaluation Scales

The severity of spasticity can vary significantly among different individuals and can range from mild to severe.

For example, a patient with a mild spasticity disorder may exhibit have difficulty with high-level physical activities, such as running, climbing stairs, or activities involving fine muscular control. Conversely, a patient with a more severe disorder may experience a complete loss of muscular function.

There are various evaluation scales that may be used to classify the severity of spasticity, including:

• FIM disability scale
• King’s hypertonicity scale
• Modified Ashworth scale
• Muscle spasms scale
• Tardieu scale

Associated Conditions and Differential Diagnosis

Spasticity can sometimes be mistaken for seizure activity, although there are several distinct differences between the conditions. In particularly, spasticity in not as rhythmic or symmetrical as the muscular contractions involved in a seizure and does not have a postictal period following a seizure.

Spasticity is a clinical sign that is associated with several neurological disorders, including multiple sclerosis, cerebral palsy and stroke. It often presents following an injury to the central nervous system and is also associated with neurodegenerative disease involving the upper motor neurons.

As a result, it is important that the broader health of a patient presenting with muscle spasticity is considered to ensure the correct diagnosis is made and an adequate management plan is implemented.

References

• http://emedicine.medscape.com/article/2207448-differential
• https://www.nlm.nih.gov/medlineplus/ency/article/003297.htm
• http://weillcornellbrainandspine.org/condition/spasticity/diagnosing-and-treating-spasticity
• http://www.ncbi.nlm.nih.gov/pubmed/17108887
• http://www.sciencedirect.com/science/article/pii/B9780444529015000137