Classification of upper limb spasticity patterns in patients with multiple sclerosis: a pilot observational study.
Mirko Filippetti, Linde Lugoboni, Rita Di Censo and 7 others
PMID 39185546WHAT IT FOUND
In 25 people with MS after one botulinum toxin A cycle, upper limb spasticity was grouped into six shoulder-elbow-forearm-wrist patterns; pattern 6, with internally rotated shoulder, flexed elbow and neutral forearm/wrist, was reported in 29.5% of limbs.
No treatment effect was tested.
Key findings
01Twenty-five patients with MS contributed 34 upper limbs, and six shoulder-elbow-forearm-wrist spasticity patterns were described.
02Pattern 6 was reported at 29.5% and pattern 2 at 23.5%.
03No specific hand posture was observed for the described patterns.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
This was a pilot study of 25 patients and 34 upper limbs, so pattern frequencies are preliminary. Some patterns were observed in very few limbs or people, including pattern 3 in 2 limbs and pattern 4 in 3 subjects. One expert physiatrist classified all patients, with no independent raters or photo or video checks. Assessment was clinical posture review only; no instrumental movement or muscle activity measurements were used. All participants had previously received a segmental upper limb botulinum toxin A cycle, and the study did not test outcomes, so it cannot show how spasticity patterns respond to treatment. The sample was highly disabled, with median Expanded Disability Status Scale score 7, so findings may not apply to people with MS who have less severe disability.
Declared interests
The study was funded by the Fondazione Italiana Sclerosi Multipla (FISM) for project 2022/R-Single/031.
The easy way to misread this
Do not use this as a validated classification or as a rule for choosing botulinum toxin dose. It describes postures in 25 people with MS after one botulinum toxin A cycle, uses one assessor, and reports no treatment outcomes.