The SCATS is a physiologically based measure for spastic reflexes for use in individuals with SCI.  It was developed in response to the demand for a standardized, simple clinical measure that encompasses the primary spastic reaction in the SCI population. The SCATS is split into 3 subscales, each addressing a separate spasm: clonus; flexor spasms; and extensor spasms. For each subscale, the spasm is triggered and then rated with a score ranging from 0 – 3.

Number of items: N/a

Procedure/Administration: The SCATS is administrated by a trained clinician.  SCATS clonus is measured by rapid passive dorsiflexion.  The degree of spasm is rated between 0 (no spasm) – 3 (severe spasm lasting longer than 10 seconds).  SCATS flexor spasm is measured by applying a pinprick stimulus to the medial arch with the knee and hip extended straight. The degree of spasm is rated between 0 (no spasm) and 3 (severe spasm, 30 knee and hip flexion). SCATS extensor spasm is measured by extending the hip and knee joints from with the knee and hip extended at 90 and 110 degrees. The degree of spasm is rated between 0 (no spasm) and 3 (severe spasm, longer than 10 seconds).

How scored: 3 subscales rated with a score ranging from 0-3.

Interpretability: Scores in each subscale range from 0 - 3, with scores above zero indicating the presence of spasm. Scores of three indicate severe spasms. The results of the SCATS will indicate to the clinician the type(s) of spasticity present in an individual, as well as the degree of severity of each type of spasticity.

Acceptability: As spasms are often uncomfortable for individuals with SCI, and the SCATS is recommended to be done in tandem with self reporting measures of spasm, there is the possibility of high respondent burden in terms of both length and comfort.  The measure could be conducted during a home visit or at a clinic/hospital.  

Languages: N/a

Usability: N/a

Time to administer: Each subscale is quick (<5 sec) to administer; however, if a spasm is elicited, spasm duration is patient specific and could be enduring.

Time to score: N/a

Training required: Administration should be done by a trained clinician

Availability: N/a

Equipment required: Equipment to quantitatively measure joint angle changes

Summary:

• The SCATS does not gather information on patient perspective, an important aspect of spasms, as some spasms are perceived as beneficial to the patient.
• Spasticity literature in the SCI population reveals three different forms of spasticity, each with a different reflex pathway - the SCATS appears to be comprehensive in differentiating each of these spastic responses (Little et al. 1989).

Psychometric Summary:

Note: TR= Test re-test; IC= Internal Consistency; Inter-O= Inter-observer; Intra-O= Intra-observer; SS= Sensitivity/Specificity.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

N/a= No information.

References

• Adams M, Martin Ginis K, Hicks A. “The Spinal Cord Injury Spasticity Evaluation Tool: Development and Evaluation.” Arch Phys Med Rehabil. 2007;88:1185-1192.
• Benz EN, Hornby TG, Bode RK, Scheidt RA, Schmit BD. A physiologically based clinical measure for spastic reflexes in spinal cord injury. Arch Phys Med Rehabil 2005;86:52-59.
• Little JW, Micklesen P, Umlauf R, Britell C. Lower extremity manifestations of spasticity in chronic spinal cord injury. Am J Phys Med Rehabil. 1989;68:32-36