From the Guidelines
The Triple Spasticity Scale is a valuable tool for assessing spasticity in patients with neurological conditions, and its use can lead to more targeted and effective treatment plans, as supported by recent guidelines 1, 2.
Key Components of the Triple Spasticity Scale
- The Modified Ashworth Scale (MAS), which measures resistance to passive movement
- The Tardieu Scale, which assesses velocity-dependent resistance and catch angle
- The Penn Spasm Frequency Scale, which measures the frequency of muscle spasms ### Using the Triple Spasticity Scale To use the Triple Spasticity Scale effectively, clinicians should:
- Assess patients in a relaxed position
- Test multiple muscle groups at different velocities of passive movement
- Use the scale to determine appropriate treatment strategies, which may include:
- Physical therapy
- Oral medications like baclofen (10-25mg three to four times daily) or tizanidine (2-8mg three times daily)
- Injectable treatments like botulinum toxin (dosage varies by muscle size and severity)
- In severe cases, intrathecal baclofen therapy ### Recent Guidelines and Evidence Recent guidelines support the use of botulinum toxin for patients with focal spasticity depending on patient characteristics and preferences 2. A small RCT compared the efficacy of botulinum toxin versus oral baclofen on multiple upper- and lower-limb spasticity outcomes, including the Modified Ashworth Scale and Brunnstrom Stages of Stroke Recovery 2. The guidelines also suggest offering chin tuck against resistance exercises in addition to conventional dysphagia therapy for patients with dysphagia 1, 2.
Importance of Comprehensive Assessment
The Triple Spasticity Scale is valuable because spasticity manifests in multiple ways—increased muscle tone, velocity-dependent resistance, and spontaneous spasms—and a comprehensive assessment leads to more targeted and effective treatment plans. Regular reassessment using this scale allows for monitoring treatment effectiveness and making necessary adjustments.
From the Research
Definition and Management of Spasticity
- Spasticity is a major disabling symptom in many patients with spinal and/or cerebral lesions, characterized by abnormal supraspinal drive, abnormal control of reflex activities, and changes in muscle mechanical properties 3.
- The management of spasticity seeks to reduce its burden on patients and to limit secondary complications, and can include non-operative interventions such as stretching/splinting, postural management, physical therapy/strengthening, anti-spasticity medications, and botulinum toxin injections 4.
Assessment and Treatment of Spasticity
- The treatment of spasticity requires a team approach, including the patient and caregivers, therapists, physicians, and surgeons, to determine what component of the spasticity interferes with function 5.
- Traditional therapy continues to dominate the therapy provided to patients who are living with spasticity, and may include physical and occupational therapy, oral medication, injections of botulinum toxin, use of an intrathecal baclofen pump, or surgery 5.
Non-Pharmacological Interventions for Spasticity
- There is "moderate" evidence for electro-neuromuscular stimulation and acupuncture as an adjunct therapy to conventional routine care in persons following stroke 6.
- There is "low" quality evidence for rehabilitation programs targeting spasticity, such as induced movement therapy, stretching, dynamic elbow-splinting, occupational therapy, in stroke and other neurological conditions 6.