Composite Spasticity Index (CSI)

Original Editor - Arnold Fredrick D'Souza

Top Contributors - Arnold Fredrick D'Souza, Chloe Waller, Lucinda hampton and Kim Jackson  

Objective

The Composite Spasticity Index (CSI) is a tool designed to quantify the spasticity of limbs.

Intended Population

Although primarily intended for use in patients with stroke, it has been used in patients with spinal cord injury and cerebral palsy.

Method of Use

The CSI has three components:

1. Tendon jerk
2. Resistance to passive flexion
3. Clonus

Tendon jerk

The biceps, triceps, patellar, or Achilles tendon could be chosen for testing. Ensure sufficient force is used while tapping the tendon so as to elicit a 'maximal' reflex jerk and compare the result with the unaffected limb.

0	No response
1	Normal response
2	Mildly hyperactive response
3	Moderately hyperactive response
4	Maximally hyperactive response

Resistance to passive flexion

The resistance felt during passive flexion allows the examiner to evaluate the hyperactivity of the tonic stretch reflex. The magnitude of resistance to passive stretch is noted at moderate speed (>100 degrees per second).

Note the presence of contractures and/or a clasp-knife response before examination.

0	No resistance (hypotonic)
2	Normal resistance
4	Mildly increased resistance
6	Moderately increased resistance
8	Maximally increased resistance

Clonus

On rapid flexion of the wrist or ankle, the examiner notes the number of beats of clonus (if present).

1	Clonus not elicited
2	1-3 beats of clonus elicited
3	3-10 beats of clonus elicited
4	Sustained clonus

Interpretation

The composite score (sum of scores from each component) is used to ascertain the severity of spasticity.

0-9	Mild
10-12	Moderate
13-16	Severe

Links

A copy of the outcome measure can be found here.