Composite Spasticity Index (CSI): Difference between revisions
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# [[Clonus of the Ankle Test|Clonus]] | # [[Clonus of the Ankle Test|Clonus]] | ||
==== Tendon jerk ==== | ==== 1. Tendon jerk ==== | ||
The [[Biceps Brachii|biceps]], [[Triceps brachii|triceps]], [[Patellar tendon tear|patellar]], or [[Achilles Tendinopathy|Achilles]] tendon can be tested. Ensure sufficient force is used while tapping the tendon so as to elicit a 'maximal' [[Reflexes|reflex]] jerk and compare the result with the unaffected limb.<ref name=":0" /> | The [[Biceps Brachii|biceps]], [[Triceps brachii|triceps]], [[Patellar tendon tear|patellar]], or [[Achilles Tendinopathy|Achilles]] tendon can be tested. Ensure sufficient force is used while tapping the tendon so as to elicit a 'maximal' [[Reflexes|reflex]] jerk and compare the result with the unaffected limb.<ref name=":0" /> | ||
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==== Resistance to passive stretch ==== | ==== 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).<ref name=":0" /> | 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).<ref name=":0" /> | ||
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This item is doubly weighted due to its close relation to hypertonus. | This item is doubly weighted due to its close relation to hypertonus. | ||
==== Clonus ==== | ==== 3. Clonus ==== | ||
On rapid flexion of the [[Wrist & Hand|wrist]] or [[Clonus of the Ankle Test|ankle]], the examiner notes the number of beats of clonus (if present).<ref name=":0" /> | On rapid flexion of the [[Wrist & Hand|wrist]] or [[Clonus of the Ankle Test|ankle]], the examiner notes the number of beats of clonus (if present).<ref name=":0" /> | ||
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=== Validity === | === Validity === | ||
The CSI is valid for the examination of spasticity in elbow flexors | The CSI is valid for the examination of spasticity in elbow flexors<ref>Levin MF, Feldman AG. [https://pubmed.ncbi.nlm.nih.gov/7820623/ The role of stretch reflex threshold regulation in normal and impaired motor control]. Brain Res. 1994 Sep 19;657(1-2):23-30.</ref>. A meta analysis supports that CSI scores correlate with [[Upper Limb Function in Spinal Cord Injury|upper limb function]]<ref>Francis HP, Wade DT, Turner-Stokes L, Kingswell RS, Dott CS, Coxon EA. [https://pubmed.ncbi.nlm.nih.gov/15489384/ Does reducing spasticity translate into functional benefit? An exploratory meta-analysis]. J Neurol Neurosurg Psychiatry. 2004 Nov;75(11):1547-51</ref>. 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<ref>Lu X, Hu N, Deng S, Li J, Qi S, Bi S. [https://pubmed.ncbi.nlm.nih.gov/26834338/ 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.</ref>. | ||
=== Responsiveness === | === Responsiveness === | ||
Revision as of 15:51, 21 August 2022
Original Editor - Arnold Fredrick D'Souza
Top Contributors - Arnold Fredrick D'Souza, Chloe Waller, Lucinda hampton and Kim Jackson
Objective[edit | edit source]
The Composite Spasticity Index (CSI) is used for the quantification of spasticity in hemiparetic limbs.[1]
Intended Population[edit | edit source]
It is intended for use in patients with stroke[1], spinal cord injury and cerebral palsy[2].
Method of Use[edit | edit source]
The CSI has three components:
- Tendon jerk
- Resistance to passive flexion
- Clonus
1. Tendon jerk[edit | edit source]
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[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).[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[edit | edit source]
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[edit | edit source]
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[edit | edit source]
Reliability[edit | edit source]
The CSI has excellent test-retest reliability (r = 0.87)[3].
Validity[edit | edit source]
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[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]
- ↑ 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.
