Tabla. Escalas de espasticidad validadas según la patología. |
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Descripción de la escala |
Validación por patología |
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MAS |
Califica la resistencia (incremento de tono) de los músculos al movimiento pasivo |
Ictus, lesión medular, daño cerebral, parálisis cerebral, esclerosis múltiple [30] |
MTS |
Califica la resistencia (incremento de tono) de los músculos al movimiento pasivo a diferentes velocidades |
Ictus, lesión medular, daño cerebral, parálisis cerebral, esclerosis múltiple [31,32] |
PSFS |
Autoevaluación que mide la frecuencia e intensidad de los espasmos musculares |
Lesión medular [33] |
TSS |
Mide la espasticidad basándose en los reflejos tónicos y fásicos, y en la resistencia pasiva |
Ictus cardioembólico [33] |
SCATS |
Evalúa la intensidad de tres componentes: clonías, espasmos flexores y extensores |
Lesión medular [34] |
MAS: escala modificada de Ashworth; MTS: escala modificada de Tardieu; PSFS: Penn Spasm Frequency Scale; SCATS: Spinal Cord Assessment Tool for Spastic Reflexes; TSS: Triple Spasticity Scale. |
Figura. Algoritmo para la evaluación y tratamiento de la espasticidad.
Spasticity in neurological pathologies. An update on the pathophysiological mechanisms, advances in diagnosis and treatment Introduction. Spasticity is a frequent clinical sign in people with neurological diseases that affects mobility and causes serious complications: pain, joint limitation, muscular contractions and bed sores, which have a significant effect on the individual’s functionality and quality of life. Aim. To review the integration, description and critical interpretation of the most recent scientific evidence on the clinical variability of spasticity and associated symptoms, the different pathophysiological mechanisms and their relevance in the diagnostic and therapeutic approach. Development. A search was conducted in the scientific publications on the different aspects of spasticity grouped into two main categories: cerebral and spinal cord pathologies. The epidemiological, clinical and pathophysiological aspects, clinical and instrumental diagnoses, and the physiotherapeutic, pharmacological and surgical approach to spasticity in each group of pathologies were all reviewed. Conclusion. Spasticity is related to structural lesions and maladaptive neuroplastic changes that determine an important variability in its clinical expression. Although its diagnosis presents important limitations, the use of clinical and neurophysiological diagnostic tools aimed at achieving different approaches in cases of neurological pathologies originating in the brain and in the spinal cord could optimise the effectiveness of spasticity therapies. Key words. Baclofen. Functionality. Hyperactivity. Hyperreflexia. Plasticity. Spasticity. |