Reliability of an Algorithm to Diagnose Spasticity
Condition: Spasticity
MeSH terms: Muscle Spasticity
Study type: Observational

Summary: 
      Spasticity is a condition that results from damage to the central nervous system and causes
      painful muscle contractures that drastically affect level of independence, activities of
      daily living, and quality of life. Although there are well-known and accepted treatments for
      spasticity, spasticity is often left undertreated; the specific reasons for this observation
      are unknown. Because there is no blood test or scan that indicates the presence of
      spasticity, diagnosis is based entirely on physician impression. Therefore, the investigators
      hypothesize that one reason that spasticity is undertreated is due to the lack of a
      standardized diagnostic procedure. This study attempts to test the reliability of a
      diagnostic flowchart that seeks to increase the accuracy of physician diagnosis of
      spasticity.
    

Detailed description: 
      Spasticity is defined as a velocity-dependent increase in stretch reflex with muscle
      overactivity, and is associated with involuntary limb movements or spasms which can often be
      painful. Active function (such as walking, driving, writing, or sexual activity) can be
      adversely affected by spasticity. For patients with significant disability requiring a
      caregiver, passive function (such as facilitation of bathing, dressing, and undergarment
      change) can also become very difficult, especially when spasticity is left untreated.
      Finally, persistent involuntary motion or spasms may negatively impact an individual's mood
      or self image, making social situations more difficult and sometimes overwhelming.

      Spasticity is especially undertreated in vulnerable populations; population surveys in
      individuals with intellectual disability and nursing home residents have shown that less than
      20% of affected individuals are treated. There are severe negative consequences of leaving
      spasticity untreated, like muscle shortening and tendon and soft tissue contractures. Once
      developed, contractures are very difficult to treat and can hinder personal hygiene and
      dressing, and well as the ability to sit or lie properly. Bad hygiene and immobility can
      lead, in turn, to urinary tract infections, pressure ulcers and skin breakdown. Furthermore,
      spasticity can stunt muscle growth and cause abnormal bone growth and formation, especially
      in children.

      Spasticity is diagnosed based upon a physician's clinical impression; there is currently no
      biomarker to facilitate an objective diagnosis. The two instruments most commonly used to
      document severity are the Modified Ashworth Scale and Range of Motion Assessment. Both
      assessments are based upon a clinician's assessment of muscle tone, but there is no
      widely-accepted protocol to determine the presence of spasticity. We therefore hypothesize
      one reason spasticity is widely undertreated is the challenge faced by physicians when
      attempting to make a diagnosis. In the absence of a biomarker, a more standardized method of
      clinical diagnosis is necessary, both for future research and for advocacy efforts. The
      treatment of spasticity could increase quality of life by allowing an individual to
      participate more independently in activities of daily living, and by making assistance easier
      for caregivers.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Nursing home residents
      
Keywords: Spasticity; Diagnostic Algorithm