Spasticity

Spasticity is derived from the Greek word spasticus, which means “to pull.” It is a component of the
upper motor neuron syndrome (UMNS), which is caused by a lesion proximal to the anterior horn
cell; in the spinal cord, brainstem, or brain.

Spasticity: A motor disorder characterized by an abnormal, velocity-dependent increase in the tonic stretch
reflexes (muscle tone) with exaggerated phasic stretch reflexes (tendon jerks, clonus) resulting from
hyperexcitability of the stretch reflex. It is a component of the UMNS.

The quicker examiner extend the joint (i.e elbow) , the more resistance is felt
Etiology
stroke,
Spasticity is a component of the UMNS and can result from numerous conditions, such as
cerebral palsy (CP), anoxic brain injury, traumatic brain injury (TBI),
spinal cord injury (SCI), multiple sclerosis (MS), and other CNS
neurodegenerative diseases.
Muscle Tone Exam (MAS)
Spasticity Examination
Tardieu Scale:
– Evaluating muscles moving at different velocities helps distinguish musculotendinous stiffness from
spasticity
– For each muscle group tested, the joint is moved at three different velocities (V1, V2, V3).
The quality of muscle reaction and angle at which muscle reaction occurs are recorded.
Velocities:
V1—Joint is moved as slow as possible
V2—Speed of limb segment falls with gravity
V3—Joint is moved as fast as possible
Muscle response quality:
0—No resistance through range of motion (ROM)
1—Slight resistance throughout ROM, no clear catch
2—Clear catch interrupting passive movement, followed by release 3—Fatigable
clonus (<10 seconds)
4—Nonfatigable clonus (>10 seconds)
5—Joint is immovable
Modified Tardieu Scale
Modified Tardieu Scale:
– R1 and R2 components added to Tardieu Scale
– R1 is defined as the angle at which muscle reaction occurs during V3 (fastest
velocity).
– R2 is defined as the angle at which muscle reaction occurs during V1 (slowest
velocity).
– A large difference between R1 and R2 indicates that velocity-dependent tone (i.e.,
spasticity)
is predominant, while a small difference between R1 and R2 indicates that velocity-
independent tone (such as from muscle contracture) is predominant.
Rigidity
Rigidity: Resistance to stretch that is not velocity dependent—the examiner feels
the same resistance to stretch irrespective of the velocity at which a muscle group is
being stretched.
Means that if examiner try to flex or extend it, quickly or slowly, it still encounter
the same amount of resistance

Damage or lesion on the basal ganglia (extrapyramidal tract)

Examination
• Passively moving the arm, leg or neck to feel the resistance, the
resistance remain the same on both agonist and antagonist muscle

• If smooth and consistent  Lead-Pipe

• If Rachet-like Quality  Cogwheel
Clonus: Alternating muscle contraction and relaxation of agonist and
antagonist muscles

Involuntary and rhythmic muscle contractions caused by a permanent

lesion in descending motor neurons
It is usually accompanied by spasticity
Clonus Reflexes
Ankle/Achilles reflex (S1/S2 nerve routes)
Jaw jerk/masseter: Trigeminal nerve, tested at the
chin/mental protuberance
Patellar/quadriceps/knee: L2 to L4 (mostly L4),
tested just inferior to the patella (or by pushing
patella distally)
Biceps: C5 to C6, just anterior to elbow
Triceps: C7 to C8 (mostly C7), just posterior to the
elbow
Examination