How is spasticity diagnosed?
A typical patient journey
People with a spasticity diagnosis are usually cared for in different environments throughout the healthcare journey – all of which have different treatment aims.
In stroke or intensive care units and other hospital wards, the main focus is on the patient’s survival after an upper motor neuron syndrome (UMNS) event.1 Following this acute phase, the focus shifts towards the rehabilitation and general care of the affected person.2 If the person is sent to a nursing home, however, generally only basic care is provided.3
Post-stroke spasticity is most effectively diagnosed and treated by a team of healthcare professionals that includes rehabilitation specialists, occupational therapists, physiotherapists, speech therapists, psychologists, social workers and nurses. These experts work together to provide patients with different treatment options.4,5
Diagnosis and clinical evaluation
A proper assessment of clinical and neurological status is critical in developing an effective treatment plan with achievable goals. A spasticity diagnosis will be based on5:
A proper assessment of clinical and neurological status is critical in developing an effective treatment plan with achievable goals.
Spasticity diagnosis is suspected based on a history of a neurological disorder and on a specific abnormal posture caused by increased muscle tone. Spasticity is confirmed if the patient shows an increased resistance to passive movements that are further increased with speed.6
The diagnosis is not complicated for rehabilitation specialists and can be achieved with various tools.
The most common diagnostic tools are:
Nerve blocks: local transient anaesthesia of nerve(s) to evaluate the involvement of muscles in a specific spastic pattern5
Electromyography: to evaluate the activity of muscles via external electrodes while the patient performs a movement or a task7,8
The specific postures seen in patients with spasticity are of particular interest, as they help identify the muscles affected by spasticity. This is crucial for determining an appropriate treatment.5
The features of spasticity should be assessed individually for every patient, with a focus on three main areas9:
Overall motor difficulties
Ability to control the muscles
How muscle stiffness and any contractures worsen functional problems
References
1National Heart, Lung and Blood Institute. 2023. Stroke: Treatment. Last updated 26 May 2023. National Institutes of Health. Available at: https://www.nhlbi.nih.gov/health/stroke/treatment [accessed September 2025].
2National Institute of Neurological Disorders and Stroke (NINDS). April 2020. Post-stroke rehabilitation. NIH Publication No. 20-NS-4846. National Institutes of Health. Available at: https://catalog.ninds.nih.gov/sites/default/files/publications/post-stroke-rehabilitation.pdf [accessed September 2025].
3Meijer R, Wolswijk A, Eijsden HV. Prevalence, impact and treatment of spasticity in nursing home patients with central nervous system disorders: a cross-sectional study. Disabil Rehabil. 2017 Feb;39(4):363-371. doi: 10.3109/09638288.2016.1146351.
4Royal College of Physicians. Spasticity in adults: management using botulinum toxin. National Guidelines. 2018. Available at: https://archive-rcplondon.zedcloud.co.uk/file/12449/download%202018 [accessed September 2025].
5Escaldi S, Bianci F, Bavikatte G, Molteni F, Moraleda S, Deltombe T, Francisco G. Module 1: pathophysiology and assessment of spasticity; goal setting. J Int Soc Phys Rehabil Med. 2022 5(Suppl 1):S3-S22. doi: 10.4103/2349-7904.347807.
6Hodge JO, Brandmeir CL, Brandmeir NJ. Neuromodulation therapies for spasticity control: now and beyond. Neurol India. 2020 Nov-Dec;68(Supplement):S241-S248. doi: 10.4103/0028-3886.302464.
7Trompetto C, Marinelli L, Mori L, Pelosin E, Currà A, Molfetta L, Abbruzzese G. Pathophysiology of spasticity: implications for neurorehabilitation. Biomed Res Int. 2014;2014:354906. doi: 10.1155/2014/354906.
8Luo Z, Lo WLA, Bian R, Wong S, Li L. Advanced quantitative estimation methods for spasticity: a literature review. J Int Med Res. 2020 Mar;48(3):300060519888425. doi: 10.1177/0300060519888425.
9Esquenazi A. Evaluation and management of spastic gait in patients with traumatic brain injury. J Head Trauma Rehabil. 2004 Mar-Apr;19(2):109-18. doi: 10.1097/00001199-200403000-00004.