COSMIN database

Psychometric evidence of spasticity measurement tools in cerebral palsy children and adolescents: a systematic review

Flamand, V. H., Masse-Alarie, H., and Schneider, C.
OBJECTIVE: To conduct a systematic review using validated critical appraisal scales to analyze both the quality and content of the psychometric evidence of spasticity measurement tools in cerebral palsy children and adolescents.

DATA SOURCES: The literature search was performed in 3 databases (Pubmed, CINAHL, Embase) up to March 2012.

STUDY SELECTION: To be retained for detailed review, studies had to report on at least one psychometric property of one or many spasticity assessment tool(s) used to evaluate cerebral palsy children and adolescents.

DATA EXTRACTION: Two raters independently reviewed admissible articles using a critical appraisal scale and a structured data extraction form.

DATA SYNTHESIS: A total of 19 studies examining 17 spasticity assessment tools in cerebral palsy children and adolescents were reviewed. None of the reviewed tools demonstrated satisfactory results for all psychometric properties evaluated, and a major lack of evidence concerning responsiveness was emphasized. However, neurophysiological tools demonstrated the most promising results in terms of reliability and discriminating validity.

CONCLUSIONS: This systematic review revealed insufficient psychometric evidence for a single spasticity assessment tool to be recommended over the others in pediatric and adolescent populations.
J Rehabil Med
1651-2081 (Electronic)
Publication year:
Biological and physiological variables:
Biological and physiological variables
Symptom status:
Physical state
Children (0-18)
Congenital malformations, deformations and chromosomal abnormalities and related symptoms
Diseases of and symptoms related to the musculoskeletal system and connective tissue
Diseases of and symptoms related to the nervous system
PRO / non-PRO:
Non-patient Reported Outcome
Type of measurement instrument:
4 - Performance-based tests
6 - Clinical rating scales
9 - Laboratory tests
3D-pendulum - Three-dimensional pendulum test
AS - Ashworth scale
CSS - Composite Spasticity Scale
EMG - electromyography
Goniometry / Goniometer   
HAT - Hypertonia Assessment Tool
H-reflex - Hoffmann reflex of soleus muscle
Inertial sensors
L-STIFF - Stiffness tool with robotic-assisted gait orthosis
MAS - Modified Ashworth Scale   
Myotonometry OR Myometry [Alias: Myotonometer]
Tonic stretch reflex testing
TS - Tardieu Scale (versions: MTS - Modified TS)
WPT - Wartenberg Pendulum Test