Spinal Cord Assessment Tool for Spastic Reflexes

Link to instrument: Available on scireproject.com

Acronym:

SCATS

Purpose:

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

Description:

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 = 10-30degrees 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 to110 degrees of hip and knee flexion

• Extensor spasms are rated on a 4 point scale that is identical to clonus scale above

Area of Assessment: Spasticity

Body Part: Lower Extremity

ICF Domain: Body Structure, Body Function

Domain: Motor

Assessment Type: Observer

Length of Test: 06 to 30 Minutes

Time to Administer:

5 to 10 minutes

Number of Items: 3 sub-scales (clonus, flexor and extensor spasms)

Equipment Required:

None

Training Required:

None, however, the Spinal Cord Assessment Tool for Spastic Reflexes (SCATS) is typically administered by a trained clinician.

Type of training required: No Training

Cost: Free

Actual Cost:

Free

Age Range: Adolescent: 13-17 years, Adult: 18-64 years, Elderly adult: 65+

Administration Mode: Paper/Pencil

Diagnosis: Spinal Cord Injury

Populations Tested:

• Spinal Cord Injury

Standard Error of Measurement (SEM):

Not Established

Minimal Detectable Change (MDC):

Not Established

Minimally Clinically Important Difference (MCID):

Not Established

Cut-Off Scores:

Not Established

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

Test-retest Reliability:

Not Established

Interrater/Intrarater Reliability:

Not Established

Internal Consistency:

Not Applicable

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 (Convergent/Discriminant):

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

Content Validity:

Not Established

Face Validity:

Not Applicable

Floor/Ceiling Effects:

Not Established

Responsiveness:

Not Established

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.

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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

Year published: 2007

Instrument in PDF Format: Yes

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