Spasticity assessment in cerebral palsy

Spasticity is an important, but not the only, component contributing to the increased joint resistance experienced by children with spastic cerebral palsy. Conventional clinical spasticity scales, based on physical examination of the passive muscle, are easy to apply in pediatric populations. Unfortunately, these have low reliability and are unable to differentiate between the different components of joint hyper-resistance. To correctly differentiate spasticity from other neural and non-neural contributions, instrumented assessments that integrate electrophysiological and biomechanical measures are required. In the last 15 years, great advancements in clinically applicable, instrumented assessments were made. However, the translation from research to clinical setting is lagging behind. Simple, yet accurate, instrumented assessments are expected to greatly advance clinical practice in terms of treatment planning based on etiological classification and subsequent outcome evaluation. In addition, the transfer of the research findings to functional outcome would require to extend our research agenda to include assessments of hyperreflexia in the active muscle. Altogether these instrumented methods are not only needed to classify different aspects of joint hyper-resistance but will also provide further insight into its pathophysiology enabling the development of future treatment options for children with spastic cerebral palsy.