Relationship between self- and clinically rated spasticity in spinal cord injury

OBJECTIVES: To assess the relation between self- and clinically rated spasticity in spinal cord injury (SCI) and to determine the extent to which symptoms like pain are included in the patients' self-rating of spasticity. DESIGN: Part 1: an observational, prospective, cross-sectional study and part 2: an observational, prospective, longitudinal study. SETTING: Swiss paraplegic center. PARTICIPANTS: Forty-seven (part 1) and 8 (part 2) persons with spastic SCI (American Spinal Injury Association grade A or B). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Clinical rating of movement-provoked spasticity using the Ashworth Scale; self-rating of general and present spasticity by the subject on a 4-point spasm severity scale and by using a visual analog scale (VAS); and questionnaires asking for antispasticity medication, impact of spasticity on daily life, body segment affected by spasticity, and symptoms associated with its occurrence. RESULTS: There was a poor correlation (rho=.36) between clinically rated (Ashworth Scale) spasticity and self-rated general spasticity and a modest correlation (rho=.70) between Ashworth Scale and self-rated present spasticity in the cross-sectional study in 47 subjects. Questionnaires showed that symptoms like pain and other sensations were associated by the patients with spasticity. There was a significant, but weak, correlation between VAS and Ashworth Scale in the longitudinal study in 3 of the 8 subjects and nonsignificant correlations in the remaining 5 subjects. CONCLUSIONS: A single clinical assessment of spasticity is a poor indication of a patient's general spasticity. Clinical measures of muscle tone-related spasticity should be complemented by self-rating that distinguishes muscle tone-related spasticity from spasticity affecting the sensory nervous system.     

The drawing test: assessment of coordination abilities and correlation with clinical measurement of spasticity

OBJECTIVE: To assess the correlation between kinematic measures of movement (Drawing Test) and a clinical measure of spasticity (Ashworth Scale). DESIGN: Correlation study of Drawing Test and the Ashworth Scale scores. SETTING: Inpatient rehabilitation center. PARTICIPANTS: Forty-five poststroke hemiplegic subjects with various levels of spasticity (up to Ashworth Scale score of 3) and 8 able-bodied subjects with no sensorimotor deficits in their upper extremities. INTERVENTIONS: Subjects made self-paced, radial point-to-point movements between the left, and the right corners of a square (200 x 200 mm) on the surface of a drawing tablet. Hand coordinates were recorded from the mouse, which was attached to the hand. MAIN OUTCOME MEASURES: Correlation between (1) Drawing Test scores (time to perform the movement, radial [ y ] and tangential [ x ] distances between the end point of the movement and the target endpoint, standard error of the mean calculated as distances between the recorded path and its radial linear fit), and (2) Ashworth Scale scores. RESULTS: Drawing Test scores correlated highly with Ashworth Scale scores in 49 of 53 subjects, based on the multiple linear regression analysis. CONCLUSIONS: The Drawing Test, a quantitative metric of movement ability, correlated highly to the Ashworth Scale, a clinical measure of spasticity.     

表面肌电在评估偏瘫患者肘关节肌张力中的应用

目的探索肱二头肌、肱三头肌表面肌电(sEMG)特征与偏瘫患者肘关节肌张力的关系。方法同一治疗师对37 例脑损伤后偏瘫患者的患侧肘关节进行改良Ashworth 量表(MAS)评估,同时用sEMG记录被动活动时肱二头肌和肱三头肌的表面肌电信号。结果经Spearman 相关分析,被动屈肘时,肱二头肌(r=0.651)、肱三头肌(r=0.912)、肱三头肌+肱二头肌(r=0.905)、肱三头肌-肱二头肌(r=0.903)的均方根值(RMS)与MAS 相关(P<0.001);被动伸肘时,肱二头肌(r=0.848)、肱三头肌(r=0.518)、肱三头肌+肱二头肌(r=0.850)、肱二头肌-肱三头肌(r=0.711)的RMS 与MAS 相关(P<0.001)。结论sEMG 能检测主动肌和拮抗肌的肌电活动,对临床肌张力评估和痉挛的治疗提供量化的参考。     

Insulin growth factors may explain relationship between spasticity and skeletal muscle size in men with spinal cord injury

The major objectives of this cross-sectional study were to (1) measure insulin-like growth factor-1 (IGF-1) in individuals with complete spinal cord injury (SCI) and spasticity and (2) determine the relationships between IGF-1 and cross-sectional areas (CSAs) of thigh skeletal muscle groups. Eight individuals with motor complete SCI underwent magnetic resonance imaging to measure the CSA of the whole thigh, knee extensor, and knee flexor skeletal muscle groups and dual-emission X-ray absorptiometry to measure fat-free mass. After participants fasted for 12 h, we measured their IGF-1 levels and determined spasticity using the Modified Ashworth Scale (MAS). Spearman rho correlations were used to test for the relationships among the tested variables, and independent t-tests were used to determine the difference in plasma IGF-1. Plasma IGF-1 was 44% greater in those with MAS scores of 2 or higher (p < 0.05). Plasma IGF-1 was positively related to knee extensor skeletal muscle CSA (r = 0. 83, p < 0.01). IGF-1 was strongly related to knee extensor and flexor spasticity (r = 0.88, p < 0.004). The findings suggest that IGF-1 is greater in SCI individuals with increased spasticity, and this may explain the strong positive relationships that were noted between spasticity and skeletal muscle CSA.     

基于表面肌电探讨蝶形浴对脑卒中偏瘫患者上肢痉挛的影响

目的:基于表面肌电(sEMG)观察蝶形浴对脑卒中偏瘫患者上肢痉挛的影响。方法:采用随机数字表法将60例脑卒中偏瘫患者分为观察组和对照组各30例。2组患者均给予常规的康复治疗,观察组患者在此基础上进行蝶形浴治疗。分别于治疗前、治疗4周后采用表面肌电图记录肘关节屈曲最大等长收缩时肱二头肌与肱三头肌积分肌电值(IEMG)、改良Ashworth量表(MAS)来评估2组患者患侧肘关节及腕关节的肌张力大小,采用简易Fugl-Meyer上肢运动功能评分(FMA-U)评估2组患者的上肢运动功能。结果:治疗4周后,2组患者肘关节屈曲最大等长收缩时肱二头肌IEMG均较治疗前明显降低(均P0.05),且观察组更低于对照组(P0.05);肱三头肌IEMG均较治疗前明显增高(均P0.05),且观察组更高于对照组(P0.05);2组患侧肘、腕关节屈肌MAS评分均较治疗前下降(均P0.05),且观察组明显低于对照组(P0.05);2组患侧FMA-U评分均较治疗前明显提高(P0.05),且观察组明显高于对照组(P0.05)。结论:蝶形浴疗法可以有效地缓解脑卒中偏瘫患者的上肢痉挛,减轻因痉挛导致的上肢运动功能障碍,值得在临床推广应用。     

低频重复经颅磁刺激联合肌电生物反馈疗法对脑卒中患者上肢功能的临床研究

目的:观察低频重复经颅磁刺激(rTMS)联合肌电生物反馈(EMGBFT)治疗脑卒中患者上肢痉挛及其运动功能的临床疗效。方法:脑卒中伴上肢痉挛患者45名,随机分为3组(A、B、C),每组患者各15名。3组患者均给予常规康复治疗,B组另外给予EMGBFT治疗,C组另外给予低频rTMS联合EMGBFT治疗。3组患者均于治疗前、治疗4周后和第8周随访时进行改良Ashworth分级、表面肌电图(sEMG)、上肢Fugl-Meyer评定法(UFMA)以及改良Barthel指数(MBI)进行评估。结果:治疗4周时,3组患者改良Ashworth分级、sEMG、UFMA和MBI较治疗前差异有统计学意义(P0.05),C组的评估指标与其余2组比较差异均有统计学意义(P0.05)。第8周随访时A组患者各项评估指标较第4周时差异有统计学意义(P0.05),其余2组患者变化无统计学差异。结论:低频重复经颅磁刺激联合肌电生物反馈治疗可以有效缓解脑卒中患者上肢痉挛,提高上肢功能。     

A型肉毒毒素注射配合康复训练治疗痉挛型脑性瘫痪儿童下肢肌张力障碍

目的探讨A型肉毒毒素（BTX-A）在脑性瘫痪（脑瘫）治疗中的应用及疗效。方法将34例痉挛型双瘫患儿随机分为治疗组和对照组，治疗组采用BTX-A局部多点注射结合康复训练，对照组仅行康复训练，2组治疗前及治疗后3d、2周、1个月、2个月和3个月采用改良的Ashworth痉挛分级量表、粗大运动功能量表（GMFM）及印油毯足印分析进行疗效评估。结果治疗组治疗3d后，对照组治疗1个月后痉挛评分下降。与治疗前比较，差异有统计学意义（P〈0．05）；治疗2周至3个月，2组痉挛评分比较，差异有统计学意义（P〈0．05）。2组治疗1个月和3个月后GMFM评分均有提高，治疗3个月后治疗组与对照组相比，差异有统计学意义（P〈0．05）。印油毯足印分析显示，治疗组治疗3个月后步行足长、步速与治疗前及与对照组比较，差异有统计学意义（P〈0．05），步幅评分2组均有明显提高（P〈0．05），但组问差异无统计学意义（P〉0．05）。结论BTX-A注射配合康复训练可快速有效地缓解脑瘫患儿下肢痉挛及提高其步行功能，缩短住院疗程。     

Multiple Sclerosis and Postural Control: The Role of Spasticity

Sosnoff JJ, Shin S, Motl RW. Multiple sclerosis and postural control: the role of spasticity.

Objectives

To examine the association between spasticity and postural control in subjects with multiple sclerosis (MS).

Design

Cross-sectional.

Setting

Motor control laboratory.

Participants

Subjects with MS (n=16, 2 male) and age and sex-matched subjects (n=16) participated in the investigation. All subjects with MS had Expanded Disability Status Scale scores between 0 and 4.5 and modified Ashworth scale scores between 1 and 3.

Interventions

Not applicable.

Main Outcome Measures

Postural control was measured with a force platform that quantifies ground reaction forces and moments in mediolateral and anteroposterior directions. Postural control was indexed with anterior-posterior sway range, medial-lateral sway range, 95% elliptical area of the deviations of center of pressure (COP), velocity of COP sway, and the frequency at which 95% of spectral profile was contained. Participants with MS further underwent assessment of the soleus Hoffman reflex (H-reflex) as an index of spasticity.

Results

Cluster analysis on H-reflex data identified groups of MS participants with high spasticity (n=7) and low spasticity (n=9). There were no differences in age, duration of MS, and disease severity between MS groups. There were no differences in anterior-posterior sway range between any of the groups. The high spasticity group had greater COP area, velocity, and mediolateral sway compared with the low spasticity and control group, and the low spasticity group had postural control values between the high spasticity and control groups.

Conclusions

The pattern of results suggests that spasticity contributes to postural deficits observed in MS.     

脑卒中患者肢体痉挛的发生率及其与功能的关系

目的：探讨脑卒中患者肢体痉挛的发生率及其与功能的关系。方法：评定50例急性脑卒中患者的肌张力，在病程6个月时采用改良Ashworth量表（MAS）、Fugl-meyer运动功能（FMA）及Barthel指数（BI）分别评定患者肌张力、运动功能和日常生活活动能力。结果：在病程满6个月时患者中大多数存在肢体肌张力增高，MAS分级与FMA和BI得分间呈显著负相关（P〈0.001）。结论：脑卒中偏瘫患者痉挛发生率较高，而且痉挛程度与运动功能和日常生活活动能力显著相关,康复治疗应关注痉挛问题。     

全身低频渐进振动联合运动治疗对卒中患者下肢肌张力与步行能力的作用

目的:探究全身低频渐进振动联合运动治疗对卒中患者下肢肌张力与步行能力的作用。方法:选取符合入选标准的脑卒中患者67例,编号后随机分为对照组34例和观察组33例。2组均给予常规康复治疗,观察组在此基础上给予全身低频渐进振动联合运动治疗。治疗前后采用改良Ashworth分级(MAS)、表面肌电信号(sEMG)、10m步行试验和功能性步行量表(FAC)进行评定。结果:治疗6周后,2组股四头肌、小腿三头肌MAS评级、RMS均值、10m步行时间均较治疗前明显降低(P0.01,0.05),且观察组更低于对照组(P0.05,0.01)。治疗后,2组FAC评级均较治疗前明显提高(均P0.01),且观察组更高于对照组(P0.05)。结论:全身低频渐进振动联合运动治疗能改善卒中患者下肢肌张力,提升步行能力。     

等速测试指标与改良Ashworth法用于评定肌痉挛的相关性研究

目的：研究等速被动测试指标与改良Ashworth法在进行肌痉挛评定中的相关性。方法：对20例脑损伤后肌痉挛患者进行肌张力研究。使用改良Ashworth评定量表进行肌张力评定，然后采用Biodex System-3型等速测试仪，对痉挛下肢进行等速被动测试，设定膝关节测试运动角速度分别为30°/s，120°/s，180°/s，测定峰阻矩（peak torque，PT）和峰阻矩/体重比（peak torque/body weight，PT/BW）两个指标。采用Spearman 法对上述两组结果进行相关分析。 结果：所测两个指标分别与改良Ashworth评分进行相关分析，相关系数在0.633—0.962（P＜0.01）。结论：在肌痉挛评定中，Ashworth法与等速测试法所得结果高度相关，在反映肌痉挛方面具有一致性。     

Spasticity in children with cerebral palsy: a retrospective review of the effects of intrathecal baclofen

The administration of baclofen by intrathecal pump is a new technique used to reduce spasticity for individuals with upper motor neuron system injuries. Children with cerebral palsy often have difficulty in mobility because of this form of spasticity. The purpose of this study was to assess the functional outcomes of intrathecal baclofen pump therapy with spasticity in children with cerebral palsy. A retrospective review of medical records for pediatric cerebral palsy patients receiving intrathecal baclofen for intractable spasticity was performed. Of 23 sequential medical records meeting requirements for inclusion in the study, 17 subjects had sufficient recorded data to be included in the study. Data from the medical records included Ashworth scores, therapy complications, and changes in mobility and independence. Although no significant changes in the upper extremities with intrathecal baclofen occurred at one and three months, the trial bolus showed statistically significant changes in mean Ashworth scores. The pre- and posttrial bolus Ashworth scores for the lower extremities showed statistically significant decreases in the posttrial scores and at one and three months when compared with the pretrial scores (p < .001). Complications were resolved with conservative management without long-term sequelae. No infections, respiratory depressions, or deaths occurred as a result of intrathecal baclofen therapy in this study. Although intrathecal baclofen had a significant effect in reducing lower extremity spasticity in children with cerebral palsy, further prospective studies are needed to determine the effects of intrathecal baclofen on such indicators as activities of daily living.     

中医推拿颤法对脑卒中痉挛的影响

目的观察中医推拿颤法对脑卒中偏瘫患者痉挛的影响。方法脑卒中痉挛性偏瘫患者44 例,随机分对照组(n=22)和观察组(n=22),对照组采用现代康复技术加常规推拿,观察组采用现代康复技术加中医推拿颤法。治疗前及治疗4 周后,采用改良Ashworth 评定量表(MAS)、简化Fugl-Meyer 评定量表(FMA)、Barthel 指数(BI)进行评定。结果治疗后,两组MAS 评分无显著性差异(P>0.05),FMA及BI 评分较治疗前均有提高(P<0.05),观察组治疗前后差值高于对照组(P<0.05)。结论中医推拿颤法能促进脑卒中痉挛性偏瘫患者运动功能和日常生活活动能力的恢复。     

肌内效贴联合运动控制训练对脑瘫患儿运动功能影响的研究

目的:观察肌内效贴联合运动控制训练对痉挛型脑瘫双下肢痉挛及粗大运动功能的影响。方法:收集痉挛型脑瘫患儿58例,随机分为观察组和对照组各29例。对照组进行常规康复功能训练,观察组在对照组治疗基础上加用肌内效贴及运动控制治疗。2组患儿均于治疗前和治疗3个月后,采用踝关节被动活动范围(PROM)、改良Ashworth痉挛分级量表(MAS)、粗大运动功能量表(GMFM)中的D区、E区进行测定。结果:治疗后,2组患儿PROM角度、GMFM(D、E区)得分均较组内治疗前明显提高(P0.05),MAS评分明显降低(P0.05),观察组各项评分较对照组改善更为显著(P0.05)。结论:肌内效贴配合运动控制训练能有效缓解痉挛型脑瘫下肢痉挛并提高粗大运动功能。     

体外冲击波联合肌电生物反馈对痉挛型脑瘫患儿下肢运动能力的影响

目的探讨体外冲击波(ESWT)联合肌电生物反馈对痉挛型脑瘫患儿下肢运动能力的影响。方法选取2～7岁痉挛型脑瘫患儿50例, 按照随机数字表法将其分为对照组和实验组, 每组25例。两组患儿均接受肌电生物反馈和常规康复治疗, 实验组在此基础上给予低能量ESWT治疗。治疗前及治疗8周后(治疗后), 采用肌电设备采集两组患儿胫骨前肌的积分肌电值(iEMG)和均方根值(RMS), 利用改良Ashworth量表(MAS)、改良Tardieu量表评定法(MTS)、粗大运动功能评定量表(GMFM-88)D区与E区分别评定两组患儿的下肢痉挛程度及运动能力。结果治疗前, 两组患儿胫骨前肌表面肌电iEMG和RMS, MAS、MTS、GMFM-88结果比较, 差异无统计学意义(P>0.05)。治疗后, 两组患儿胫骨前肌表面肌电iEMG和RMS, MAS、MTS中R1、MTS中R2与R1的差值、GMFM-88 D区和E区结果均较组内治疗前改善(P<0.05)。实验组治疗后胫骨前肌表面肌电iEMG[(67.04±12.84)μV·s]和RMS[(69.32±12.84)μV], MAS[(1.98±0....     

Validity, reliability, and clinical importance of change in a 0-10 numeric rating scale measure of spasticity: a post hoc analysis of a randomized, double-blind, placebo-controlled trial

BACKGROUND: The measurement of spasticity as a symptom of neurologic disease is an area of growing interest. Clinician-rated measures of spasticity purport to be objective but do not measure the patient's experience and may not be sensitive to changes that are meaningful to the patient. In a patient with clinical spasticity, the best judge of the perceived severity of the symptom is the patient. OBJECTIVES: The aim of this study was to assess the validity and reliability, and determine the clinical importance, of change on a 0-10 numeric rating scale (NRS) as a patient-rated measure of the perceived severity of spasticity. METHODS: Using data from a large,randomized, doubleblind, placebo-controlled study of an endocannabinoid system modulator in patients with multiple sclerosis-related spasticity, we evaluated the test-retest reliability and comparison-based validity of a patient-reported 0-10 NRS measure of spasticity severity with the Ashworth Scale and Spasm Frequency Scale. We estimated the level of change from baseline on the 0-10 NRS spasticity scale that constituted a clinically important difference (CID) and a minimal CID (MCID) as anchored to the patient's global impression of change (PGIC). RESULTS: Data from a total of 189 patients were included in this assessment (114 women, 75 men; mean age, 49.1 years). The test-retest reliability analysis found an interclass correlation coefficient of 0.83 (P < 0.001) between 2 measures of the 0-10 NRS spasticity scores recorded over a 7- to 14-day period before randomization. A significant correlation was found between change on 0-10 NRS and change in the Spasm Frequency Scale (r = 0.63; P < 0.001), and a moderate correlation was found between the change on 0-10 NRS and the PGIC (r = 0.47; P < 0.001). A reduction of approximately 30% in the spasticity 0-10 NRS score best represented the CID and a change of 18% the MCID. CONCLUSIONS: The measurement of the symptom of spasticity using a patient-rated 0-10 NRS was found to be both reliable and valid. The definitions of CID and MCID will facilitate the use of appropriate responder analyses and help clinicians interpret the significance of future results.     

A clinical study of intrathecal baclofen using a programmable pump for intractable spasticity

OBJECTIVE: To determine the impact of intrathecal baclofen (ITB) therapy on outcomes of functional independence, pain, subjective improvement, performance, and standard measures of spasticity. DESIGN: A noncomparative, multicenter, prospective cohort trial of patients with implanted pumps followed up over a 12-month period for the assessment of spasticity, pain, and function. SETTING: Twenty-four European centers of neurology or rehabilitation familiar with implantable pump technique participated. PARTICIPANTS: Patients with intractable spasticity (N=138) who responded positively to a trial dose of baclofen (n=133) and who began ITB therapy (n=129) were enrolled. INTERVENTION: Implantation of a Medtronic SynchroMed Infusion System with the administration of ITB therapy. MAIN OUTCOME MEASURES: Ashworth Scale assessment, Penn Spasm Frequency Scale scores, pain assessment, FIM instrument scores or WeeFIM scores for children, Canadian Occupational Performance Measure (COPM), and subjective ratings of overall relief were the tools administered. RESULTS: Muscle tone, spasm scores, and pain intensity reductions were observed. Overall FIM scores increased significantly in cognitive and motor function. COPM scores for both performance and satisfaction also improved significantly. Patients reported increased relief from pain and spasticity, supported by physician reports. Forty-three percent of patients reported adverse events, mostly related to patients' underlying conditions (20%), the device implant surgery (10%), or complications with the catheter (9%). CONCLUSIONS: ITB therapy using a programmable pump is clinically effective and well tolerated, despite a seemingly high level of adverse events, in patients with intractable spasticity of spinal or cerebral origin and may offer improvements in pain relief and function.     

Effectiveness of a home-based exercise program among patients with lower limb spasticity post-stroke: A randomized controlled trial

PurposeTo evaluate the effectiveness of advanced practice nurse–guided home-based rehabilitation exercise program (HREPro) among patients with lower limb spasticity post-stroke.MethodsThis randomized controlled study recruited 121 patients with lower limb spasticity post-stroke. Intervention (n = 59) and control (n = 62) groups underwent 12-month HREPro and conventional rehabilitation, respectively, after discharge. The Fugl–Meyer assessment of spasticity measurement, modified Ashworth scale of motor function, 10-Meter Walk Test of walking ability, and Barthel index of activities of daily living (ADL) were evaluated at 0, 3, 6, and 12 months after discharge.ResultsSignificant differences were found in spasticity degree, motor function, walking ability, and ADL at 6 and 12 months after discharge between the control and intervention groups. Lower limb spasticity and ADL in the intervention group were significantly improved.ConclusionHREPro is effective for rehabilitation of patients with lower limb spasticity post-stroke and has favorable home application.     

重复经颅磁刺激对痉挛型脑瘫患儿痉挛及运动功能的影响

目的:本研究拟初步探讨重复经颅磁刺激(rTMS)对痉挛型脑瘫患儿痉挛及运动功能的影响。方法:将痉挛型脑瘫患儿40例随机分为观察组和对照组各20例,2组均接受常规康复治疗,观察组在常规康复治疗的基础上增加rTMS治疗。2组患儿分别在治疗前、治疗2周、4周后进行Ashworth评分、踝关节活动度及粗大运动功能量表(GMFM-88)评定。结果:治疗后,2组患儿小腿三头肌Ashworth分级组内治疗前后及组间比较差异均无统计学意义。治疗2周及4周后,观察组踝关节背屈活动度逐渐提高,且差异有统计学意义(P<0.01),对照组踝关节活动度变化差异无统计学意义,2组治疗2周后差异无统计学意义,到治疗4周后比较差异才有统计学意义(P<0.01)。观察组治疗2周与治疗前比较,GMFM-88评定中D区和E区得分差异无统计学意义,治疗4周与治疗2周后比较明显提高(P<0.05);对照组治疗前后比较差异均无统计学意义,2组治疗2周后,D区和E区得分差异无统计学意义,4周后比较差异有统计学意义(P<0.05)。结论:rTMS结合常规康复治疗可以有效缓解痉挛,提高痉挛型脑瘫患儿的运动功能。     

The effect of hippotherapy on spasticity and on mental well-being of persons with spinal cord injury

OBJECTIVES: To determine the effect of hippotherapy on spasticity and on mental well-being of persons with spinal cord injury (SCI), and to compare it with the effects of other interventions. DESIGN: Crossover trial with 4 conditions. SETTING: Swiss paraplegic center. PARTICIPANTS: A volunteer sample of 12 people with spastic SCI (American Spinal Injury Association grade A or B). INTERVENTIONS: Hippotherapy, sitting astride a Bobath roll, and sitting on a stool with rocking seat. Each session lasted 25 minutes and was conducted twice weekly for 4 weeks; the control condition was spasticity measurement without intervention. MAIN OUTCOME MEASURES: Clinical rating by a blinded examiner of movement-provoked muscle resistance, using the Ashworth Scale; self-rating of spasticity by subjects on a visual analog scale (VAS); and mental well-being evaluated with the self-rated well-being scale Befindlichkeits-Skala of von Zerssen. Assessments were performed immediately after intervention sessions (short-term effect); data from the assessments were analyzed 3 to 4 days after the sessions to calculate the long-term effect. RESULTS: By analyzing the clinically rated spasticity, only the effect of hippotherapy reached significance compared with the control condition (without intervention); median differences in the Ashworth scores' sum before and after hippotherapy sessions ranged between -8.0 and +0.5. There was a significant difference between the spasticity-reducing effect of hippotherapy and the other 2 interventions in self-rated spasticity by VAS; median differences of the VAS before and after hippotherapy sessions ranged between -4.6 and +0.05cm. There were no long-term effects on spasticity. Immediate improvements in the subjects' mental well-being were detected only after hippotherapy (P=.048). CONCLUSIONS: Hippotherapy is more efficient than sitting astride a Bobath roll or on a rocking seat in reducing spasticity temporarily. Hippotherapy had a positive short-term effect on subjects' mental well-being.