Spasticity Management Teams, Evaluations, and Tools: A Canadian Cross-Sectional Survey

Abstract

Objective: The objective of this study is to determine the physical evaluations and assessment tools used by a group of Canadian healthcare professionals treating adults with spasticity. Methods: A cross-sectional web-based 19-question survey was developed to determine the types of physical evaluations, tone-related impairment measurements, and assessment tools used in the management of adults with spasticity. The survey was distributed to healthcare professionals from the Canadian Advances in Neuro-Orthopedics for Spasticity Congress database. Results: Eighty study participants (61 physiatrists and 19 other healthcare professionals) completed the survey and were included. Nearly half (46.3%, 37/80) of the participants reported having an inter- or trans-disciplinary team managing individuals with spasticity. Visual observation of movement, available range of motion determination, tone during velocity-dependent passive range of motion looking for a spastic catch, spasticity, and clonus, and evaluation of gait were the most frequently used physical evaluations. The most frequently used spasticity tools were the Modified Ashworth Scale, goniometer, and Goal Attainment Scale. Results were similar in brain- and spinal cord-predominant etiologies. To evaluate goals, qualitative description was used most (37.5%). Conclusion: Our findings provide a better understanding of the spasticity management landscape in Canada with respect to staffing, physical evaluations, and outcome measurements used in clinical practice. For all etiologies of spasticity, visual observation of patient movement, Modified Ashworth Scale, and qualitative goal outcomes descriptions were most commonly used to guide treatment and optimize outcomes. Understanding the current practice of spasticity assessment will help provide guidance for clinical evaluation and management of spasticity.

Post-Stroke Spastic Movement Disorder and Botulinum Toxin A Therapy: Early Detection And Early Injection

“…The efficacy of BoNT-A in the treatment of PS-SMD has been extensively studied. BoNT-A is considered as the treatment of choice for focal, multi-focal, and segmental PS-SMD, including spastic hypertonia, increased muscle tone, spastic dystonia, clonus, and spasms [ 2 , 3 , 5 , 6 ].…”

“…PSS or PS-SMD that is perceived by the affected individual or care giver as hindering body functions, activities, and/or participation is defined as disabling PSS or disabling PS-SMD [ 2 , 4 ]. Published prevalent data of a severe spasticity (defined as increased muscle tone equal or more than 2 of the modified Ashworth scale [MAS]) and a disabling PSS (defined as spasticity that does need treatment) showed that up to 13%–16% of stroke survivors suffer from this complication after stroke [ 2 , 4 , 5 ].…”