Composite Spasticity Index (CSI)
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 a tool designed to quantify the spasticity of limbs.
Intended Population[edit | edit source]
Although primarily intended for use in patients with stroke, it has been used in patients with spinal cord injury and cerebral palsy.
Method of Use[edit | edit source]
The CSI has three components:
- Tendon jerk
- Resistance to passive flexion
- Clonus
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.
| 0 | No response |
| 1 | Normal response |
| 2 | Mildly hyperactive response |
| 3 | Moderately hyperactive response |
| 4 | Maximally hyperactive response |
Resistance to passive flexion[edit | edit source]
The resistance felt during passive flexion allows the examiner to evaluate the hyperactivity of the tonic stretch reflex. The magnitude of resistance to passive stretch is noted at moderate speed (>100 degrees per second).
Note the presence of contractures and/or a clasp-knife response before examination.
| 0 | No resistance (hypotonic) |
| 2 | Normal resistance |
| 4 | Mildly increased resistance |
| 6 | Moderately increased resistance |
| 8 | Maximally increased resistance |
Clonus[edit | edit source]
On rapid flexion of the wrist or ankle, the examiner notes the number of beats of clonus (if present).
| 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.
| 0-9 | Mild |
| 10-12 | Moderate |
| 13-16 | Severe |
Evidence[edit | edit source]
Reliability[edit | edit source]
Validity[edit | edit source]
Responsiveness[edit | edit source]
Links[edit | edit source]
A copy of the outcome measure can be found here.
