Study design: Review of the literature on the validity and reliability of assessment of spasticity and spasms. Objectives: Evaluate the most frequently used methods for assessment of spasticity and spasms, with particular focus on individuals with spinal cord lesions. Setting: Clinic for Spinal Cord Injuries, Rigshospitalet, University Hospital of Copenhagen, and Department of Medical Physiology, University of Copenhagen, Denmark. Methods: The assessment methods are grouped into clinical, biomechanical and electrophysiological, and the correlation between these is evaluated. Results: Clinical methods: For assessment of spasticity, the Ashworth and the modified Ashworth scales are commonly used. They provide a semiquantitative measure of the resistance to passive movement, but have limited interrater reliability. Guidelines for the testing procedures should be adhered to. Spasm frequency scales seem not to have been tested for reliability. Biomechanical methods such as isokinetic dynamometers are of value when an objective quantitative measure of the resistance to passive movement is necessary. They play a minor role in the daily clinical evaluation of spasticity. Electrophysiological methods: These techniques have provided valuable insight to the pathophysiological mechanisms involved in spasticity, but none of these techniques provide an easy and reliable assessment of spasticity for use in the daily clinic. Conclusion: A combination of electrophysiological and biomechanical techniques shows some promise for a full characterization of the spastic syndrome. There is a need of simple instruments, which provide a reliable quantitative measure with a low interrater variability.

Reduced depression of transmitter release from Ia afferents following previous activation (post-activation depression) has been suggested to be involved in the pathophysiology of spasticity. However, the effect of this mechanism on the myotatic reflex and its possible contribution to increased reflex excitability in spastic participants has not been tested. To investigate these effects, we examined post-activation depression in Soleus H-reflex responses and in mechanically evoked Soleus stretch reflex responses. Stretch reflex responses were evoked with consecutive dorsiflexion perturbations delivered at different intervals. The magnitude of the stretch reflex and ankle torque response was assessed as a function of the time between perturbations. Soleus stretch reflexes were evoked with constant velocity (175 degrees /s) and amplitude (6 degrees) plantar flexion perturbations. Soleus H-reflexes were evoked by electrical stimulation of the tibial nerve in the popliteal fossa. The stretch reflex and H-reflex responses of 30 spastic participants (with multiple sclerosis or spinal cord injury) were compared with those of 15 healthy participants. In the healthy participants, the magnitude of the soleus stretch reflex and H-reflex decreased as the interval between the stimulus/perturbation was decreased. Similarly, the stretch-evoked torque decreased. In the spastic participants, the post-activation depression of both reflexes and the stretch-evoked torque was significantly smaller than in healthy participants. These findings demonstrate that post-activation depression is an important factor in the evaluation of stretch reflex excitability and muscle stiffness in spasticity, and they strengthen the hypothesis that reduced post-activation depression plays a role in the pathophysiology of spasticity.

The present study examined whether isometric strength training alone or isometric strength training combined with flexibility training of the hamstring muscles altered the viscoelastic response during stretch. Twelve male subjects performed isometric training (strength) on one side and isometric and flexibility training (strength and flexibility) on the other side for 13 weeks; 10 other subjects served as controls. Passive torque offered by the hamstring muscle group was measure during passive knee extension using a dynamometer. The knee was passively extended to a predetermined final position at 0.0875 rad/sec (dynamic phase), where it remained stationary for 90 seconds (static phase). The slope of the line (stiffness) and the area under the curve (energy) in the dynamic phase, and the decline in passive torque (viscoelastic stress relaxation) in the static phase were analyzed. Isometric strength was determined with a dynamometer. A strength test and a stretch maneuver were administered before and after the training period. All variables were unchanged in the control group. Isometric strength increased similarly on both training sides by 43%. The stretch maneuver showed that energy, stiffness, and passive torque increased on both training sides while low-level electromyographic recordings remained constant. Furthermore, the viscoelastic stress relaxation response (31% to 33%) was unaffected by the training. The addition of flexibility exercise had no significant effect on these strength training responses. These data suggest that an increase in isometric strength is accompanied by changes in the material properties of the muscle that are unaffected by flexibility exercises.