Composite Spasticity Index (CSI)
Original Editor - Arnold Fredrick D'Souza
Objective[edit | edit source]
Intended Population[edit | edit source]
Method of Use[edit | edit source]
The CSI has three components:
- Tendon jerk
- Resistance to passive flexion
Tendon jerk[edit | edit source]
The biceps, triceps, patellar, or Achilles tendon could be chosen for testing. Ensure sufficient force is used while tapping the tendon so as to elicit a 'maximal' reflex jerk and compare the result with the unaffected limb.
|2||Mildly hyperactive response|
|3||Moderately hyperactive response|
|4||Maximally hyperactive response|
Resistance to passive stretch[edit | edit source]
The resistance felt during this test allows the examiner to evaluate the hyperactivity of the tonic stretch reflex. The stretch must be performed at moderate speed (>100 degrees per second).
Note the presence of contractures and/or a clasp-knife response before examination.
|0||No resistance (hypotonic)|
|4||Mildly increased resistance|
|6||Moderately increased resistance|
|8||Maximally increased resistance|
This item is doubly weighted due to its close relation to hypertonus.
Clonus[edit | edit source]
|1||Clonus not elicited|
|2||1-3 beats of clonus elicited|
|3||3-10 beats of clonus elicited|
Interpretation[edit | edit source]
The composite score (sum of scores from each component) is used to ascertain the severity of spasticity.
Evidence[edit | edit source]
Reliability[edit | edit source]
The CSI has excellent test-retest reliability (r = 0.87).
Validity[edit | edit source]
The CSI is valid for the examination of spasticity in elbow flexors.
Responsiveness[edit | edit source]
The responsiveness of the CSI has not been studied.
Links[edit | edit source]
A copy of the outcome measure can be found here.
References[edit | edit source]
- Calota A, Levin MF. Tonic stretch reflex threshold as a measure of spasticity: implications for clinical practice. Top Stroke Rehabil. 2009 May-Jun;16(3):177-88.
- Levin MF, Hui-Chan CW. Conventional and acupuncture-like transcutaneous electrical nerve stimulation excite similar afferent fibers. Arch Phys Med Rehabil. 1993 Jan;74(1):54-60.
- Levin MF, Feldman AG. The role of stretch reflex threshold regulation in normal and impaired motor control. Brain Res. 1994 Sep 19;657(1-2):23-30.