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  2. Spinal Cord Assessment Tool for Spastic Reflexes

Spinal Cord Assessment Tool for Spastic Reflexes

Last Updated

Purpose

Assesses three types of spastic motor behaviors in SCI patients - clonus, flexor spasms, and extensor spasms.

Link to Instrument

Instrument Details

Acronym SCATS

Area of Assessment

Spasticity

Assessment Type

Observer

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Spinal Cord Injury

Populations

Spinal Injuries

Key Descriptions

  • Administered by a trained clinician, the SCATS Clonus scale uses passive dorsiflexion to assess clonus.
  • Clonus is rated on a 4-point scale that ranges from:
    0 = No reaction
    1 = Mild lasting < 3sec
    2 = Moderate lasting 3-10 seconds
    3 = Severe lasting > 10 seconds
  • SCATS flexor spasm is assessed with a pinprick to the medial arch with the knee and hip fully extended.
  • Flexor spasms are rated on a 4-point scale that ranges from:
    0 = No reaction
    1 = mild, less than 10 degrees of excursion in flexion at knee and hip, or extension of the great toe
    2 = moderate = 10-30 degrees of flexion at knee and hip
    3 = Severe with > 30 degrees of hip and knee flexion
  • SCATS extensor spasms are assessed by extending the hip and knee joints from a start position of 90 to 110 degrees of hip and knee flexion.
  • Extensor spasms are rated on a 4-point scale that is identical to clonus scale above.

Number of Items

3 sub-scales

Time to Administer

5-10 minutes

Required Training

No Training

Age Ranges

Adolescent

13 - 17

years

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by the Rehabilitation Measures Team in 2011; Updated by Phyllis Palma, PT, DPT and the SCI EDGE task force of the Neurology Section of the APTA in 9/2012.

Body Part

Lower Extremity

ICF Domain

Body Structure
Body Function

Measurement Domain

Motor

Professional Association Recommendation

 

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (SCI EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (VEDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

 

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

 

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

 

Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post) 

(Vestibular < 6 weeks post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

SCI EDGE

LS

LS

LS

 

Recommendations based on SCI AIS Classification: 

 

AIS A/B

AIS C/D

SCI EDGE

LS

LS

 

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

SCI EDGE

No

No

No

Not reported

Considerations

  • Further testing for reliability and responsiveness of SCATS is required (Hsieh at al, 2008) 
  • SCATS differs from other measures as it assesses multijoint spasms, versus a single joint. 

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Spinal Injuries

back to Populations

Normative Data

Acute SCI: (Kumru et al, 2010; n = 15; mean age = 36.2 (15.8) years; mean time since SCI = 7.3 (3.9); Spasticity affected both legs in all participants)

 

Significant improvement in spasticity of the lower limb was experienced in patients after active high frequency repetitive transcranial magnetic stimulation (rTMS), results follows:

SCAT Norm Data in Experimental Conditions:

 

 

Time of Stimulation

Active

Sham

Before Stimulation

5.9 (2.3)

5.2 (1.9)

After First Session

4.2 (1.8)

4.7 (2.3)

After Last Session

4.6 (1.8)

4.5 (2.1)

One Week After Stimulation

4.2 (2.2)

4.5 (2.1)

p

.01

.18

p value refers to the results of Friedman’s test

 

 

Criterion Validity (Predictive/Concurrent)

Acute and Chronic SCI: (Benz st al, 2005; n = 11; ages ranged from 16 to 65; months post injury ranged from 3 to 360 months)

Correlation of the SCATS and Kinematic and Electromyographic Measures

 

 

 

 

Laboratory based measure

Clinical measure

Strength

rho

p

Vastus medialis duration

Extensor SCATS

Excellent

.90

< 0.001

Soleus duration

Extensor SCATS

Excellent

.70

< 0.001

Extensor SCATS

Extensor SCATS

Excellent

.94

< 0.001

Medial gastrocnemius duration

Clonus SCATS

Excellent

.69

0.002

Clonus SCATS

Clonus SCATS

Excellent

.90

< 0.001

Ankle excursion angle

Flexor SCATS

Excellent

.69

< 0.001

Knee excursion angle

Flexor SCATS

Excellent

.81

< 0.001

Hip excursion angle

Flexor SCATS

Excellent

.82

< 0.001

Flexor SCATS

Flexor SCATS

Excellent

.87

< 0.001

Construct Validity

Acute and Chronic SCI: (Benz st al, 2005)

SCATS, Ashworth Scale, and PSFS Correlations~:

 

 

 

 

 

 

 

Ashworth Hip

Ashworth Knee

Ashworth Ankle

SCATS Clonus

SCATS Flexion

SCATS Extension

PSFS

.43 (A)

.43 (A)

.51 (A)

.59* (A)

.41 (A)

.40

Ashworth hip

.90** (E)

.67* (E)

.56 (A)

.55* (A)

.98** (E)

 

Ashworth knee

.77** (E)

.65* (E)

.47 (A)

.88** (E)

 

 

Ashworth ankle

.60* (E)

.40 (A)

.61* (E)

 

 

 

SCATS clonus

.35 (A)

.59* (A)

 

 

 

 

SCATS flexion

.56* (A)

 

 

 

 

 

Strength:

(E) = Excellent

(A) = Adequate

 

 

 

 

 

 

PSFS = Penn Spasm Frequency Scale

~ Spearman Rank-Order Correlation

*Significant at P < 0.05

**Significant at P < 0.01

 

 

 

 

 

 

Bibliography

Benz, E. N., Hornby, T. G., et al. (2005). "A physiologically based clinical measure for spastic reflexes in spinal cord injury." Arch Phys Med Rehabil 86(1): 52-59. Find it on PubMed

Hsieh, J., Wolfe, D., et al. (2007). "Spasticity outcome measures in spinal cord injury: psychometric properties and clinical utility." Spinal Cord 46(2): 86-95. Find it on PubMed

Kumru, H., Murillo, N., et al. (2010). "Reduction of Spasticity With Repetitive Transcranial Magnetic Stimulation in Patients With Spinal Cord Injury." Neurorehabilitation and neural repair 24(5): 435. Find it on PubMed

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