Development of tools to assess function in the spastic upper limb

Through related work the need for further assessment of upper limb function has been identified. Assessing functional gain is problematic for three reasons. Firstly the goals for treatment vary widely (Sheean 2001). Secondly in some cases treatment is aimed at restoring motor control leading to independent function (termed ‘active function’). Thirdly in other cases, where paralysis is more severe, the goals for intervention may be to improve the ease of caring for the person - maintaining hygiene or ease of dressing for example (termed ‘passive function’). The management of spasticity also includes physiotherapy to stretch the affected muscles and where possible to promote motor control through practice of tasks, and is therefore further complicated by incorporating more than one intervention.
 
While functional scales, which include a standardised task battery, are useful for comparison of different patient groups, they may not reflect accurately the individual goals of each patient, and user-focussed outcomes are increasingly regarded as critical to the demonstration of success. There is therefore a need to develop functional outcome measurement tools to use alongside approaches such as Goal Attainment Scaling, which assess both active and passive function from the ecological perspective of the "patient".

Main Projects

Work has been undertaken in the form of a systematic review to identify pre-existing tools, which may be valuable in this area of outcome measurement.
 
Following this the development of a new tool the ‘Arm Activity (ArMA)’ scale is underway.

Associated reaction scale

A tool has been designed to rate the phenomenon of associated reactions in individuals with arm spasticity. Spasticity in the arm can be accompanied by flexion of the elbow and internal rotation at the shoulder, which is associated with physical effort and is therefore termed an associated reaction.
 
The associated reaction scale is designed to be used by raters who have clinical experience of the phenomena. Further work is planned evaluating the utility of the tool in both the research and clinical practice environments.