Development of a self-report scale of spasticity.

BACKGROUND: Although the Modified Ashworth Scale is the most common instrument used to grade spasticity, it is unsuitable for busy follow-up clinics, longer term follow-up, or community surveys. OBJECTIVES: To establish a simple questionnaire that would indicate the presence and extent of spasticity and would be suitable for use in everyday outpatient clinical practice and/or community follow-up. METHODS: Qualitative exploration of the experience and impact of spasticity among stroke patients led to the development of a short questionnaire. Rasch analysis was performed on the data and the scale items were externally validated by correlation with comparator measures. RESULTS: Forty-eight subjects were recruited for the qualitative interviews, half of whom were more than 2 years post stroke. Interviews generated items relating to spasticity that were categorized into pain, spasm, fatigue, restricted movement, loss of balance, and altered appearance. Eight items were chosen for the draft questionnaire. Five hundred questionnaires were sent, and 188 (38%) were returned. The mean age of the 188 responders was 72.6 years. In regard to health, 18.5% reported that they were in good or excellent health, and 49.7% reported only fair or poor health. Data from the 8-item scale were fitted to the Rasch measurement model. Initial fit of the 8 items was good, and all the assumptions of the model were satisfied. A strong and significant gradient was found between the summed 8-item scale and self-reported health. CONCLUSIONS: A short self-perceived scale for spasticity has been developed from grounded theory, which satisfies the most rigorous standards for measurement with fit to the Rasch model.

Peripheral nerve stimulation for trigeminal neuropathic pain.

Facial pain is a complex disease with a number of possible etiologies. Trigeminal neuropathic pain (TNP) is defined as pain caused by a lesion or disease of the trigeminal branch of the peripheral nervous system resulting in chronic facial pain over the distribution of the injured nerve. First line treatment of TNP includes management with anticonvulsant medication (carbamazepine, phenytoin, gabapentin, etc.), baclofen, and analgesics. TNP, however, can be a condition difficult to adequately treat with medical management alone. Patients with TNP can suffer from significant morbidity as a result of inadequate treatment or the side effects of pharmacologic therapy. TNP refractory to medical management can be considered for treatment with a growing number of invasive procedures. Peripheral nerve stimulation (PNS) is a minimally invasive option that has been shown to effectively treat medically intractable TNP. We present a case series of common causes of TNP successfully treated with PNS with up to a 2 year follow-up. Only one patient required implantation of new electrode leads secondary to electrode migration. The patients in this case series continue to have significant symptomatic relief, demonstrating PNS as an effective treatment option for intractable TNP. Though there are no randomized trials, peripheral neuromodulation has been shown to be an effective means of treating TNP refractory to medical management in a growing number of case series. PNS is a safe procedure that can be performed even on patients that are not optimal surgical candidates and should be considered for patients suffering from TNP that have failed medical management.