A concise practical clinical guide to identifying spasticity in neurological shoulder dysfunction

Damon Hoad; Stephen Ashford; Ganesh Bavikatte; Rachel Farrell; Adrian Robertson; Jörg Wissel

doi:10.3389/fneur.2024.1440955

A concise practical clinical guide to identifying spasticity in neurological shoulder dysfunction

Damon Hoad, Stephen Ashford, Ganesh Bavikatte, Rachel Farrell, Adrian Robertson, Jörg Wissel

Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Spasticity is a known complication to the hemiplegic shoulder following acquired brain injury. However, there is a current discrepancy between the diagnosis of arm spasticity and the subsequent assessment and treatment of spasticity in people with shoulder involvement. Objective: An expert panel aimed to establish a consensus and provide a simple structured approach to identifying and assessing people with spasticity of the hemiplegic shoulder. Methods: A consensus group of six spasticity experts were interviewed individually via 1-h video calls to ascertain how they assess people with arm spasticity for shoulder involvement. During an in-person meeting in March 2023, a consensus-building process was used to discuss four topics: a checklist/tool to identify shoulder involvement in upper limb spasticity, measurements/scales for assessing shoulder spasticity, ‘red flags’ for other conditions affecting the shoulder, and assessment limitations and practicalities. Results: Where there was full agreement on a topic, recommendations to overcome challenges for initial and ongoing assessment of shoulder spasticity and goal-setting were developed, and categorized as Posture, Purposeful activity and Pain (‘the three Ps’). Posture should be observed when sitting and walking, as appropriate for the person, and compared to published shoulder spasticity patterns. Purposeful activity should be assessed using a systematic approach. The presence and nature of shoulder pain should be ascertained. Recommendations on impairment- and function-related measures are given. Conclusion: This consensus guidance provides practical recommendations on identifying shoulder spasticity to support clinicians in their management of people with neurological shoulder dysfunction.

Original language	English
Article number	1440955
Journal	Frontiers in Neurology
Volume	15
DOIs	https://doi.org/10.3389/fneur.2024.1440955
Publication status	Published - 23 Jan 2025

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https://www.frontiersin.org/articles/10.3389/fneur.2024.1440955/full

Cite this

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title = "A concise practical clinical guide to identifying spasticity in neurological shoulder dysfunction",

abstract = "Background: Spasticity is a known complication to the hemiplegic shoulder following acquired brain injury. However, there is a current discrepancy between the diagnosis of arm spasticity and the subsequent assessment and treatment of spasticity in people with shoulder involvement. Objective: An expert panel aimed to establish a consensus and provide a simple structured approach to identifying and assessing people with spasticity of the hemiplegic shoulder. Methods: A consensus group of six spasticity experts were interviewed individually via 1-h video calls to ascertain how they assess people with arm spasticity for shoulder involvement. During an in-person meeting in March 2023, a consensus-building process was used to discuss four topics: a checklist/tool to identify shoulder involvement in upper limb spasticity, measurements/scales for assessing shoulder spasticity, {\textquoteleft}red flags{\textquoteright} for other conditions affecting the shoulder, and assessment limitations and practicalities. Results: Where there was full agreement on a topic, recommendations to overcome challenges for initial and ongoing assessment of shoulder spasticity and goal-setting were developed, and categorized as Posture, Purposeful activity and Pain ({\textquoteleft}the three Ps{\textquoteright}). Posture should be observed when sitting and walking, as appropriate for the person, and compared to published shoulder spasticity patterns. Purposeful activity should be assessed using a systematic approach. The presence and nature of shoulder pain should be ascertained. Recommendations on impairment- and function-related measures are given. Conclusion: This consensus guidance provides practical recommendations on identifying shoulder spasticity to support clinicians in their management of people with neurological shoulder dysfunction.",

author = "Damon Hoad and Stephen Ashford and Ganesh Bavikatte and Rachel Farrell and Adrian Robertson and J{\"o}rg Wissel",

note = "Publisher Copyright: Copyright {\textcopyright} 2025 Hoad, Ashford, Bavikatte, Farrell, Robertson and Wissel.",

year = "2025",

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doi = "10.3389/fneur.2024.1440955",

language = "English",

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T1 - A concise practical clinical guide to identifying spasticity in neurological shoulder dysfunction

AU - Hoad, Damon

AU - Ashford, Stephen

AU - Bavikatte, Ganesh

AU - Farrell, Rachel

AU - Robertson, Adrian

AU - Wissel, Jörg

PY - 2025/1/23

Y1 - 2025/1/23

N2 - Background: Spasticity is a known complication to the hemiplegic shoulder following acquired brain injury. However, there is a current discrepancy between the diagnosis of arm spasticity and the subsequent assessment and treatment of spasticity in people with shoulder involvement. Objective: An expert panel aimed to establish a consensus and provide a simple structured approach to identifying and assessing people with spasticity of the hemiplegic shoulder. Methods: A consensus group of six spasticity experts were interviewed individually via 1-h video calls to ascertain how they assess people with arm spasticity for shoulder involvement. During an in-person meeting in March 2023, a consensus-building process was used to discuss four topics: a checklist/tool to identify shoulder involvement in upper limb spasticity, measurements/scales for assessing shoulder spasticity, ‘red flags’ for other conditions affecting the shoulder, and assessment limitations and practicalities. Results: Where there was full agreement on a topic, recommendations to overcome challenges for initial and ongoing assessment of shoulder spasticity and goal-setting were developed, and categorized as Posture, Purposeful activity and Pain (‘the three Ps’). Posture should be observed when sitting and walking, as appropriate for the person, and compared to published shoulder spasticity patterns. Purposeful activity should be assessed using a systematic approach. The presence and nature of shoulder pain should be ascertained. Recommendations on impairment- and function-related measures are given. Conclusion: This consensus guidance provides practical recommendations on identifying shoulder spasticity to support clinicians in their management of people with neurological shoulder dysfunction.

AB - Background: Spasticity is a known complication to the hemiplegic shoulder following acquired brain injury. However, there is a current discrepancy between the diagnosis of arm spasticity and the subsequent assessment and treatment of spasticity in people with shoulder involvement. Objective: An expert panel aimed to establish a consensus and provide a simple structured approach to identifying and assessing people with spasticity of the hemiplegic shoulder. Methods: A consensus group of six spasticity experts were interviewed individually via 1-h video calls to ascertain how they assess people with arm spasticity for shoulder involvement. During an in-person meeting in March 2023, a consensus-building process was used to discuss four topics: a checklist/tool to identify shoulder involvement in upper limb spasticity, measurements/scales for assessing shoulder spasticity, ‘red flags’ for other conditions affecting the shoulder, and assessment limitations and practicalities. Results: Where there was full agreement on a topic, recommendations to overcome challenges for initial and ongoing assessment of shoulder spasticity and goal-setting were developed, and categorized as Posture, Purposeful activity and Pain (‘the three Ps’). Posture should be observed when sitting and walking, as appropriate for the person, and compared to published shoulder spasticity patterns. Purposeful activity should be assessed using a systematic approach. The presence and nature of shoulder pain should be ascertained. Recommendations on impairment- and function-related measures are given. Conclusion: This consensus guidance provides practical recommendations on identifying shoulder spasticity to support clinicians in their management of people with neurological shoulder dysfunction.

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A concise practical clinical guide to identifying spasticity in neurological shoulder dysfunction

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