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What condition is causing spasticity?*

Is spasticity:*

And is it:*

Does the patient find their spasticity bothersome, painful or impacting their quality of life?*

Is spasticity interfering with (check all that apply):1*


Does the patient have any of the following? (Check all that apply.)*


Which of the following spasticity treatment(s) is the patient currently receiving or has received in the past?*


As a result of current/previous spasticity treatments, which of the following results occur? (Check all that apply.)*


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Saulino M., Ivanhoe C.B., McGuire J.R., Ridley B., Shilt J.S., Boster A.L. Neuromodulation 2016 Aug;19(6):607-15. 


Lanig IS, New PW, Burns AS, Optimizing the Management of Spasticity in People With Spinal Cord Damage: A Clinical Care Pathway for Assessment and Treatment Decision Making From the Ability Network, an International Initiative. Arch Phys Med Rehabil. 2018 Aug;99(8):1681-1687


Ivanhoe CB, Tilton AH, Francisco GE. Phys Med Rehabil Clin N Am. 2001 Nov; 12(4); 923-38, viii-ix.