Penn Spasm Frequency Scale

Last Updated

January 04, 2013

Purpose

PSFS is a self-report measure that assess a patient's perception of spasticity frequency and severity following a spinal cord injury.

Acronym PSFS

Area of Assessment

Spasticity

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

Spinal Cord Injury

Spinal Injuries

Composed of 2 parts:
1) A self-report measure with items on 5-point scales developed to augment clinical ratings of spasticity and provides a more comprehensive assessment of spasticity.
2) A 3-point scale assessing the severity of spasms.
Spasm Frequency:
0 = No spasm
1 = Mild spasms induced by stimulation
2 = Infrequent full spasms occurring less than once per hour
3 = Spasms occurring more than once per hour
4 = Spasms occurring more than 10 times per hour
Spasm Severity:
1 = Mild
2 = Moderate
3 = Severe
If the patient indicates no spasms in Part 1, then they do not proceed to Part 2.

Number of Items

1 minutes

Required Training

Reading an Article/Manual

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by the Rehabilitation Measures Team in 2011; Updated by the TBI EDGE task force and Christopher Newman, PT, MPT, NCS, Jennifer Kahn, PT, DPT, NCS and the SCI EDGE task force of the Neurology Section of the APTA in 2012.

ICF Domain

Body Structure
Body Function

Measurement Domain

Motor

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit: http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

*Abbreviations:*
HR	Highly Recommend
R	Recommend
*LS / UR*	Reasonable to use, but limited study in target group / Unable to Recommend
NR	Not Recommended

Recommendations for use based on acuity level of the patient:

Acute

(CVA < 2 months post)

(SCI < 3 month post)

(Vestibular < 6 weeks post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

SCI EDGE

Recommendations based on SCI AIS Classification:

	AIS A/B	AIS C/D
SCI EDGE	LS	LS

Recommendations for entry-level physical therapy education and use in research:

	Students should learn to administer this tool? (Y/N)	Students should be exposed to tool? (Y/N)	Appropriate for use in intervention research studies? (Y/N)	Is additional research warranted for this tool (Y/N)
SCI EDGE	No	Yes	Yes	Not reported

Considerations

May not adequately record flexor and extensor spasms (Hsieh et al, 2008)
The current form of the PSFS was modified from its original version to include spasm frequency and severity. (Priebe et al, 1996)

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Normative Data

Spasticity Across Diagnosis: (Guillaume et al 2005; n = 138; 30% Multiple Sclerosis, 26% Spinal Cord Injury, 24% Cerebral Palsy, 7% Traumatic Brain Injury, 13% other; mean age = 35.2 (18.8) years)

PSFS Mean (SD) scores at:

Baseline = 2.70 (1.24)
Month 12 = 0.97 (0.95)

Internal Consistency

Chronic SCI: (Adams et al, 2007)

Excellent internal consistency (ICC = 0.90)

Criterion Validity (Predictive/Concurrent)

Chronic SCI: (Hornby et al, 2003; n = 12; mean age = 39.2 (range = 24 to 67) years; mean time since injury = 8.9 years; injury at the 8th thoracic spinal cord level or higher)

Mean Penn scores:

Patients taking anti-spastic medication = 3.0 (median = 3.0) points
Patients not taking medication = 2.17 (median = 2.0) points

Construct Validity

Chronic SCI: (Adams et al, 2007; n = 61)

Excellent: PSFS and SCI-SET correlations (r = -0.66)
Adequate: PSFS and Spasticity Severity correlations (r = 0.58*)
Excellent: PSFS and Spasticity Impact correlations (r = 0.67*)
Poor: PSFS and FIM Motor Score correlations (r = -0.05)
Adequate: PSFS and QLI Health and Functioning Sub scale correlations (r = -0.46*)

*p < .001

Spasticity Outcomes Review: (Hsieh et al, 2008) & Chronic SCI: (Benz et al, 2005; n = 15, C5 to T20, n = 12 ASIA A, n = ASIA B, n = 2 ASIA C, n = 1 ASIA D; age range = 22-63 years)

Spearman Rank-Order Correlation of the SCATS, AS, and PSFS
	AS Hip	AS Knee	AS Ankle	SCATS Clonus	SCATS Flexion	SCATS Extension
PSFS	.43	.43	.51	.59	.41	.40
Degree	Adequate	Adequate	Adequate	Adequate	Adequate	Adequate
* p < 0.05

Convenience Sample: (Priebe et al, 1996; n=85; sample of convenience, C3-T10 duration of injury 1 month - 25 years, all ASIA levels)

Adequate to Poor: Correlations between self report scales (PSFS) and clinical examinations (AS, clonus, patellar tap, achilles tap, adductor tap, planter stimulation response); none were above .4 (Polychroric Correlation)

Bibliography

Guillaume, D., Van Havenbergh, A., et al. (2005). "A clinical study of intrathecal baclofen using a programmable pump for intractable spasticity." Arch Phys Med Rehabil 86(11): 2165-2171. Find it on PubMed

Hornby, T., Rymer, W., et al. (2003). "Windup of flexion reflexes in chronic human spinal cord injury: a marker for neuronal plateau potentials?" Journal of neurophysiology 89(1): 416. Find it on PubMed

Hsieh, J. T., Wolfe, D. L., et al. (2008). "Spasticity outcome measures in spinal cord injury: psychometric properties and clinical utility." Spinal Cord 46(2): 86-95. Find it on PubMed

Priebe, M. M., Sherwood, A. M., et al. (1996). "Clinical assessment of spasticity in spinal cord injury: a multidimensional problem." Arch Phys Med Rehabil 77(7): 713-716. Find it on PubMed