Objective: To review clinical outcome assessments (COAs) used to evaluate spasticity and functional impairment in spastic paresis and provide recommendations for their use in clinical practice and research.

Background: Spasticity remains at the margins of the movement disorders spectrum despite its clinical relevance. Terminology remains inconsistent. Definitions range from a broad concept viewing spasticity as overactivity accompanying upper motor neuron lesions to the original definition describing enhancement of velocity-dependent stretch reflexes. We adopt the latter definition, consistent with recent literature and recommendations of the MDS Spasticity Study Group. In this framework, spasticity represents one component of spastic paresis, a broader syndrome including other forms of muscle overactivity such as spastic dystonia and spastic co-contraction, together with stretch-sensitive paresis and spastic myopathy.

Method: A systematic literature search identified COAs used to assess spasticity and functional performance in spastic paresis. Measurement properties (reliability, validity, sensitivity to change) were evaluated using the MDS COA-SEC appraisal scheme.

Results: Seventy-two COAs assessing spasticity were identified, of which 23 were reviewed in detail. One clinician-based instrument met criteria for recommendation, while several clinician-based and patient-reported measures were classified as recommended with caveats.

For functional performance, 71 COAs were identified, of which 14 commonly used scales were reviewed. Five lower-limb COAs met recommendation criteria, whereas upper-limb instruments showed more limited evidence and only two were recommended with caveats.

Conclusion: The Tardieu Scale is the most appropriate clinician-based tool for assessing spasticity defined as velocity-dependent stretch reflex hyperexcitability. Ashworth-derived scales should not be used, as they primarily quantify global resistance to passive movement. Functional impact of spastic paresis is best evaluated using standardized walking tests, particularly the 10-Meter Walk Test and endurance measures such as the 2-Minute or 6-Minute Walk Test. The Wisconsin Gait Scale may complement gait evaluation, while upper-limb function can be assessed using the Modified Frenchay Scale or the 13-item Arm Motor Ability Test, both ‘recommended with caveats’.

References: Gal O, Baude M, Deltombe T, Esquenazi A, Gracies JM, Hoskovcova M, Rodriguez-Blazquez C, Rosales R, Satkunam L, Wissel J, Mestre T, Sánchez-Ferro Á, Skorvanek M, Tosin MHS, Jech R; members of the MDS Clinical Outcome Assessments Scientific Evaluation Committee and MDS Spasticity Study group. Clinical Outcome Assessments for Spasticity: Review, Critique, and Recommendations. Mov Disord. 2025 Jan;40(1):22-43. doi: 10.1002/mds.30062.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-outcome-assessments-for-spasticity-and-functional-performance-in-spastic-paresis-which-scales-should-be-used/