Composite Spasticity Index (CSI)
Original Editor - Arnold Fredrick D'Souza
Top Contributors - Arnold Fredrick D'Souza, Chloe Waller, Lucinda hampton and Kim Jackson
Objective
The Composite Spasticity Index (CSI) is used for the quantification of spasticity in hemiparetic limbs.[1]
Intended Population
It is intended for use in patients with stroke[1], spinal cord injury and cerebral palsy[2].
Method of Use
The CSI has three components:
- Tendon jerk
- Resistance to passive flexion
- Clonus
1. Tendon jerk
The biceps, triceps, patellar, or Achilles tendon can be tested. 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.[1]
| 0 | No response |
| 1 | Normal response |
| 2 | Mildly hyperactive response |
| 3 | Moderately hyperactive response |
| 4 | Maximally hyperactive response |
2. Resistance to passive stretch
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).[1]
Note the presence of contractures and/or a clasp-knife response before examination[2].
| 0 | No resistance (hypotonic) |
| 2 | Normal resistance |
| 4 | Mildly increased resistance |
| 6 | Moderately increased resistance |
| 8 | Maximally increased resistance |
This item is doubly weighted due to its close relation to hypertonus.
3. Clonus
On rapid flexion of the wrist or ankle, the examiner notes the number of beats of clonus (if present).[1]
| 1 | Clonus not elicited |
| 2 | 1-3 beats of clonus elicited |
| 3 | 3-10 beats of clonus elicited |
| 4 | Sustained clonus |
Interpretation
The composite score (sum of scores from each component) is used to ascertain the severity of spasticity.[1]
| 0-9 | Mild |
| 10-12 | Moderate |
| 13-16 | Severe |
Evidence
Reliability
The CSI has excellent test-retest reliability (r = 0.87)[3].
Validity
The CSI is valid for the examination of spasticity in elbow flexors[4]. A meta analysis supports that CSI scores correlate with upper limb function[5]. For the lower limb, the CSI was found not to have concurrent validity when assessed against the Wisconsin Gait Scale or the Gait Abnormality Rating Scale for patients with hemiplegia[6].
Responsiveness
The responsiveness of the CSI has not been studied.
Links
A copy of the outcome measure can be found here.
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 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.
- ↑ 2.0 2.1 Stroke Engine. Composite Spasticity Index. Available from: https://strokengine.ca/en/assessments/composite-spasticity-index-csi/#:~:text=Index%20(CSI)%20provides%20a%20clinical,patients%20with%20hemiparesis%20following%20stroke (Accessed 21/08/2022)
- ↑ 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.
- ↑ Francis HP, Wade DT, Turner-Stokes L, Kingswell RS, Dott CS, Coxon EA. Does reducing spasticity translate into functional benefit? An exploratory meta-analysis. J Neurol Neurosurg Psychiatry. 2004 Nov;75(11):1547-51
- ↑ Lu X, Hu N, Deng S, Li J, Qi S, Bi S. The reliability, validity and correlation of two observational gait scales assessed by video tape for Chinese subjects with hemiplegia. J Phys Ther Sci. 2015 Dec;27(12):3717-21.