Data Sheet 1_A concise practical clinical guide to identifying spasticity in neurological shoulder dysfunction.pdf

BackgroundSpasticity is a known complication to the hemiplegic shoulder following acquired brain injury. However, there is a current discrepancy between the diagnosis of arm spasticity and the subsequent assessment and treatment of spasticity in people with shoulder involvement.
ObjectiveAn expert panel aimed to establish a consensus and provide a simple structured approach to identifying and assessing people with spasticity of the hemiplegic shoulder.
MethodsA consensus group of six spasticity experts were interviewed individually via 1-h video calls to ascertain how they assess people with arm spasticity for shoulder involvement. During an in-person meeting in March 2023, a consensus-building process was used to discuss four topics: a checklist/tool to identify shoulder involvement in upper limb spasticity, measurements/scales for assessing shoulder spasticity, ‘red flags’ for other conditions affecting the shoulder, and assessment limitations and practicalities.
ResultsWhere there was full agreement on a topic, recommendations to overcome challenges for initial and ongoing assessment of shoulder spasticity and goal-setting were developed, and categorized as Posture, Purposeful activity and Pain (‘the three Ps’). Posture should be observed when sitting and walking, as appropriate for the person, and compared to published shoulder spasticity patterns. Purposeful activity should be assessed using a systematic approach. The presence and nature of shoulder pain should be ascertained. Recommendations on impairment- and function-related measures are given.
ConclusionThis consensus guidance provides practical recommendations on identifying shoulder spasticity to support clinicians in their management of people with neurological shoulder dysfunction.

背景：痉挛（spasticity）是获得性脑损伤（acquired brain injury）后偏瘫肩（hemiplegic shoulder）的已知并发症。然而当前在臂部痉挛的诊断，与伴肩受累患者的痉挛后续评估及治疗之间，仍存在不一致之处。
目标：本专家小组旨在达成共识，并为偏瘫肩痉挛患者的识别与评估提供一套简洁的结构化方案。
方法：本共识小组由6名痉挛领域专家组成，通过1小时视频通话对其进行单独访谈，以明确其针对伴肩受累的臂部痉挛患者的评估流程。2023年3月召开的线下会议中，共识制定流程围绕四大议题展开讨论：用于识别上肢痉挛（upper limb spasticity）伴肩受累的核查表/工具、评估肩痉挛的测量工具/量表、影响肩部的其他疾病的危险征象（red flags），以及评估的局限性与实操要点。
结果：针对达成完全共识的议题，本研究制定了克服肩痉挛初始与持续评估、目标设定相关挑战的推荐方案，并将其归类为姿势（Posture）、有目的活动（Purposeful activity）与疼痛（Pain），即"三P原则（the three Ps）"。应根据患者情况，在坐位与行走时观察其姿势，并与已发表的肩痉挛模式进行对照。应采用系统化方法评估有目的活动。需明确肩部疼痛的存在与否与性质。本研究同时给出了与损伤及功能相关的测量推荐方案。
结论：本共识指南为肩痉挛的识别提供了实操性推荐方案，旨在帮助临床医师更好地管理神经源性肩部功能障碍患者。