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


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


METHODS
Swiss paraplegic center.


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


METHODS
Not applicable.


METHODS
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.
Lechner
Helga E
HE
Institute for Clinical Research, Swiss Paraplegic Centre, Nottwil, Switzerland. helga.lechner@paranet.ch
Frotzler
Angela
A
Eser
Prisca
P
D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000175:diagnosis* / Q000209:etiology; D009460:Neurologic Examination / Q000379:methods*; D010264:Paraplegia / Q000175:diagnosis; D010358:Patient Participation; D026741:Physical Therapy Modalities; D011336:Probability; D011446:Prospective Studies; D011782:Quadriplegia / Q000175:diagnosis; D012047:Rehabilitation Centers; D012649:Self Concept; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013119:Spinal Cord Injuries / Q000150:complications* / Q000175:diagnosis* / Q000534:rehabilitation