**2.1 History**

The ultimate goal of assessment of history is to provide a thorough history that encompasses the impact of the disease on the patient's communications and interactions with the environment and also covers all aspects of the disease. Therefore, the provision of a checklist is recommended (Appendix 1). In addition to the suggested questions, the answers to these two questions are very important in history taking and should be included in the treatment plan: Does the spasticity contribute to improving your performance? And is this spasticity a local problem or a generalized one?

between neuronal and non-neuronal causes of spasticity [1]; thus, the items addressed in **Table 2** should be noted to avoid misinterpretation [2]. It is effective to use the Tardiu scale [3] to differentiate between the neuronal component and the non-neuronal one because of the evaluation at different velocities [4]; however, it is more time-consuming than the Ashworth test. It should be noted that the suggested tests are specified for spasticity evaluation in limbs, and if one of the patient's chief complaints is trunk spasticity, the verbal or visual analog scales can be used as well as measuring the distance between two fixed points on the trunk in fast and slow

Perform three passive movements only and record the score of the resistance felt on the third

Move the limbs in the best alignment possible, record position and use when repeating measures

It is important to use outcome measures in clinical evaluation; however, it is always challenging to maintain a balance between test simplicity and speed with its reliability and validity [5], so different tests and methods have been suggested with respect to the disease diagnosis. In this book, we recommend the outcome measure of the National Hospital of Neurology and Neurosurgery (NHNN) in London with a few modifications [2], which is typically used for patients with moderate to severe

When the assessment is over and the treatment plan is being outlined, any physician should ask himself an important question: "why should I treat this spasticity?" and the more important question is "what are the patient's expectations of this treatment?" So the ultimate goal should be discussed with the patients and their caregivers to expect a realistic outcome. Since these goals are different for each patient, the following desires can be addressed: sitting comfortably in a wheelchair, adequate and comfortable night sleep, easier catheterization for bladder drainage, etc. Different algorithms [6–8] have been developed for the evaluation of and therapeutic approach to spasticity; one of the most applied of them has been developed

trunk flexions by using a tape.

movement

**Table 2.**

The score is taken within the available range

*Rehabilitation Medicine Management of Spasticity DOI: http://dx.doi.org/10.5772/intechopen.93008*

Regulate the speed by counting 1001, 1002, 1003

*Recommendations to standardize the measurement of the Ashworth scale.*

spasticity (Appendix 2).

**Figure 1.**

**89**

*Therapeutic approach to spasticity.*

by Stevenson et al. [2] and is presented in **Figure 1**.
