• Physiologically based measure for spastic reflexes for use in individuals with SCI.
  • Developed in response to the demand for a standardized, simple clinical measure that encompasses the primary spastic reaction in the SCI population.
  • The SCATS is split into 3 subscales, each addressing a separate spasm:
    1. Clonus
    2. Flexor spasms
    3. Extensor spasms

Clinical Considerations

  • The SCATS does not gather information on patient perspective, an important aspect of spasms, as some spasms are perceived as beneficial to the patient.
  • Each subscale is quick (<5 sec) to administer; however, if a spasm is elicited, spasm duration is patient specific and could be enduring.
  • The SCATS appears to be comprehensive in differentiating three different spastic responses.
  • As spasms are often uncomfortable for individuals with SCI, and the SCATS is recommended to be done in tandem with self reporting measures of spasm, there is the possibility of high respondent burden in terms of both length and comfort.
  • The measure could be conducted during a home visit or at a clinic/hospital.

ICF Domain

Body Function ▶ Neuromusculoskeletal & Movement-related Functions and Structures


  • Clinician-administered.
  • SCATS clonus is measured by rapid passive dorsiflexion.
    • The degree of spasm is rated between 0 (no spasm) – 3 (severe spasm lasting longer than 10 seconds).
  • SCATS flexor spasm is measured by applying a pinprick stimulus to the medial arch with the knee and hip extended straight.
    • The degree of spasm is rated between 0 (no spasm) and 3 (severe spasm, 30 knee and hip flexion).
  • SCATS extensor spasm is measured by extending the hip and knee joints from with the knee and hip extended at 90 and 110 degrees.
    • The degree of spasm is rated between 0 (no spasm) and 3 (severe spasm, longer than 10 seconds).

Number of Items



Equipment to quantitatively measure joint angle changes.


  • The SCATS is separated into 3 subscales.
  • For each subscale, the spasm is triggered and then rated with a score ranging from 0 – 3.



Training Required

Training is required.


Can be found here.

# of studies reporting psychometric properties: 2


  • Scores in each subscale range from 0 – 3, with scores above zero indicating the presence of spasm.
  • Scores of three indicate severe spasms.
  • The results of the SCATS will indicate to the clinician the type(s) of spasticity present in an individual, as well as the degree of severity of each type of spasticity.
  • No normative data for the SCI population has been reported.

MCID: not established in SCI
SEM: not established in SCI
MDC: not established in SCI


  • High Test-Retest kappa coefficient:
    κ = 0.614 ± 0.08 – 1.000 ± 0.08
  • High Inter-rater kappa coefficient:
    κ = 0.669 ± 1.000 (P < .01)

(Akpinar et al. 2016)


  • High correlation range with kinematic and electromyography:
    r = 0.69-0.94 (P < .01)
  • High correlation of SCATS extensor scores with Ashworth hip flexors:
    r = 0.98
  • High correlation of SCATS extensor scores with Ashworth knee flexors:
    r = 0.88
  • High correlation of SCATS extensor scores with Ashworth ankle plantar flexors:
    r = 0.61

(Benz et al. 2005)

  • High correlation of SCATS clonus scores with Modified Ashworth Scale (MAS) scores of hip extensor muscles, knee flexor muscles, and plantar flexor muscles:
    P < .01
  • High correlation of SCATS flexor spasm scores with MAS score of ankle plantar flexor muscles:
    P < .05

(Akpinar et al. 2016)


No values were reported for the responsiveness of the SCATS for the SCI population.

Floor/Ceiling Effect

No values were reported for the presence of floor/ceiling effects in the SCATS for the SCI population.


Dr. Vanessa Noonan, Matthew Querée, Gita Manhas

Date Last Updated

22 July 2020

Adams M, Martin Ginis K, Hicks A. The Spinal Cord Injury Spasticity Evaluation Tool: Development and Evaluation. Arch Phys Med Rehabil. 2007;88:1185-1192.

Akpinar P, Atici A, Ozkan FU, Aktas I, Kulcu DG, Kurt KN. Reliability of the Spinal Cord Assessment Tool for Spastic Reflexes. Archives of Physical Medicine and Rehabilitation. 2017;98:1113-8

Benz EN, Hornby TG, Bode RK, Scheidt RA, Schmit BD. A physiologically based clinical measure for spastic reflexes in spinal cord injury. Arch Phys Med Rehabil 2005;86:52-59.

Little JW, Micklesen P, Umlauf R, Britell C. Lower extremity manifestations of spasticity in chronic spinal cord injury. Am J Phys Med Rehabil. 1989;68:32-36