Measuring outcome in spasticity rehabilitation

Spasticity is a frequent consequence of upper motor neuron lesion and is as sociated with a variety of symptoms such as pain, muscle stiffness and refl ex patterns that interfere with activities of daily living, dexterity and g ait. As therapy strategies in managing spasticity-associated problems have been evolving there is an increasing need for a practicable documentation s ystem which describes spasticity and related symptoms on different levels i n order to evaluate especially the level of functioning. In daily routine the single-case-design reflects a useful technique to eval uate the status in terms of technical, functional and individual goals for treatment. However, there is no single tool to measure the different types of changes due to treatment, therefore a variety of selecting tests, based on the functional changes expected from the selected treatment, is recommen ded. The sensitivity of the selected tests should match the range of expect ed improvements related to the specific treatment. Technical goals should be evaluated by validated spasticity rating scales. As changes in technical measures of spasticity such as muscle tone, muscle length, range of motion or repetitive voluntary movements may not correlate with clinical improvements, individual functional goals should be defined. Those functional goals should reflect the patients' and care-givers' indiv idual perception of the actual problem. A treatment diary is a useful tool to document subjective perception of changes over time. Some practical issu es are adressed below. Reliable outcome measures enable patients and doctors to select further tre atment strategies and gives health care providers information on treatment expectations in return for their investments.