Inter- and intrarater reliability of the Ashworth Scale and the Disability Assessment Scale in patients with upper-limb poststroke spasticity

Background: Treatment with Botulinum toxin A (BoNT-A) is effective in decreasing upper limb spasticity. Objective: This study aimed to determine the differences in the outcome based on the upper limb motor function before BoNT-A treatment. Methods: The subjects were 61 patients who underwent BoNT-A treatment for upper limb spasticity. Limb function was evaluated using the Fugl-Meyer Assessment upper extremity (FMA-UE), modified Ashworth scale, passive range of motion and disability assessment scale before treatment as well as 2, 6, and 12 weeks after treatment. We divided the total and each subscale of FMA-UE before BoNT-A administration into beyond-the-mean-score group (higher score group) and below-the-mean-score group (lower score group). Results: In both the higher and lower score groups of the FMA-UE total and modified Ashworth scale scores improved significantly after treatment. In FMA-UE, the higher score group of subscale A improved significantly, but subscale C decreased significantly at 2 and 6 weeks after the administration. The lower score group of total, subscale A, and B improved significantly. In the disability assessment scale, the self-dressing capability at 6 weeks and limb position at 2, 6 and 12 weeks after the administration improved significantly in the higher score group. In the lower score group, the hygiene capability at 2 weeks as well as the dressing capability and limb position improved significantly at 2, 6 and 12 weeks after administration. Conclusions: The time course after administration of BoNT-A differed based on upper limb motor function before injection. When administering BoNT-A into the finger flexor muscles of a patient, we should carefully judge the indications for administration.

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Selective dorsal rhizotomy in children with spastic hemiparesis

Journal of Neurosurgery Pediatrics ◽

10.3171/2010.7.peds09318 ◽

2010 ◽

Vol 6 (4) ◽

pp. 353-358 ◽

Cited By ~ 19

Author(s):

Allison Oki ◽

Wende Oberg ◽

Beth Siebert ◽

Dutch Plante ◽

Marion L. Walker ◽

...

Keyword(s):

Stride Length ◽

The Other ◽

Assessment Scale ◽

Selective Dorsal Rhizotomy ◽

Dorsal Rhizotomy ◽

Spastic Hemiparesis ◽

Gait Assessment ◽

Modified Ashworth Scale ◽

Ashworth Scale

Object Neurological conditions including cerebral palsy, brain injury, and stroke often result in severe spasticity, which can lead to significant deformity and interfere with function. Treatments for spasticity include oral medications, intramuscular botulinum toxin type A injections, orthopedic surgeries, intrathecal baclofen pump implantation, and selective dorsal rhizotomy (SDR). Selective dorsal rhizotomy, which has been well studied in children with spastic diplegia, results in significant reduction in spasticity and improved function in children. To the authors' knowledge, there are no published outcome data for SDR in patients with spastic hemiparesis. The object of this study was to examine the effects of SDR on spastic hemiparesis. Methods A 2-year study was undertaken including all children with spastic hemiparesis who underwent SDR at the authors' institution. The degree of spasticity, as measured by the Modified Ashworth Scale or quality of gait rated using the visual gait assessment scale, the gait parameters, and velocity were compared in patients before and after undergoing SDR. Results Thirteen children (mean age 6 years 7 months) with spastic hemiparesis underwent SDR performed by the same surgeon during a 2-year period. All of the patients had a decrease in tone in the affected lower extremity after the procedure. The mean reduction in tone in 4 muscle groups (hip adductors, knee flexors, knee extensors, and ankle plantar flexors) according to the modified Ashworth scale score was 2.6 ± 1.26 (p < 0.0001). The quality of gait was assessed in 7 patients by using the visual gait assessment scale. This score improved in 6 patients and remained the same in 1. Stride length and gait velocity were measured in 4 children. Velocity increased in 3 patients and decreased in a 3-year-old child. Parents and clinicians reported an improvement in quality of gait after the procedure. Stride length increased bilaterally in 3 patients and increased on one side and decreased on the other in the other patient. Conclusions Selective dorsal rhizotomy showed efficacy in the treatment of spastic hemiparesis in children. All of the patients had decreased tone after SDR as measured by the modified Ashworth scale. The majority of patients had qualitative and quantitative improvements in gait.

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Inter- and intrarater reliability of the Modified Modified Ashworth Scale in patients with knee extensor poststroke spasticity

Physiotherapy Theory and Practice ◽

10.1080/09593980701523802 ◽

2008 ◽

Vol 24 (3) ◽

pp. 205-213 ◽

Cited By ~ 27

Author(s):

Noureddin Nakhostin Ansari ◽

Soofia Naghdi ◽

Parastoo Younesian ◽

Mohammad Shayeghan

Keyword(s):

Knee Extensor ◽

Intrarater Reliability ◽

Modified Ashworth Scale ◽

Ashworth Scale

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A physical activity program is no more effective than standard care at maintaining upper limb activity in community-dwelling people with stroke: secondary outcomes from a randomized trial

Clinical Rehabilitation ◽

10.1177/0269215519856048 ◽

2019 ◽

Vol 33 (10) ◽

pp. 1607-1613

Author(s):

Birgitta Langhammer ◽

Louise Ada ◽

Mari Gunnes ◽

Hege Ihle-Hansen ◽

Bent Indredavik ◽

...

Keyword(s):

Physical Activity ◽

Upper Limb ◽

Standard Care ◽

Community Dwelling ◽

Assessment Scale ◽

Minor Stroke ◽

Control Group ◽

Motor Assessment ◽

Significant Difference ◽

Secondary Outcomes

Objective: To evaluate whether an 18-month, physical activity coaching program is more effective than standard care in terms of upper-limb activity. Design: A prospective, randomized controlled trial. Setting: Three municipalities in Norway. Population: A total of 380 persons with stroke. Intervention: The intervention group received follow-up visits and coaching on physical activity and exercise each month for 18 months after inclusion, by a physiotherapist. The control group received standard care. Main measures: The primary outcome, in this secondary analysis, was Motor Assessment Scale items 6, 7, and 8. Secondary outcomes were National Institute of Health Stroke Scale item 5, the Stroke Impact Scale domain 7, and the Modified Ashworth Scale in flexion/extension of the elbow. Results: In total, 380 persons with stroke were recruited, with mean (SD) age 72 (11) years, and baseline scores total National Institute of Health Stroke Scale was 1.4 (2.2)/1.6 (2.4) and Motor Assessment Scale items 6, 7 and 8 in the intervention/control group was 5.5 (1.2)/5.5 (1.2), 5.4 (1.4)/5.4 (1.3), and 3.6 (2)/3.5 (2), respectively. There was no significant difference between groups in terms of upper limb function in any of the Motor Assessment Scale items. In this population with minor stroke, upper-limb activity was good at three months post-stroke (74% of the maximum) and remained good 18 months later (77% of maximum). Conclusion: After intervention, there was no difference between the groups in terms of upper-limb activity.

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Assessment of the upper limb in acute stroke: The validity of hierarchal scoring for the Motor Assessment Scale

Australian Occupational Therapy Journal ◽

10.1111/j.1440-1630.2009.00810.x ◽

2009 ◽

Vol 57 (3) ◽

pp. 174-182 ◽

Cited By ~ 9

Author(s):

Rebekah L. Pickering ◽

Isobel J. Hubbard ◽

Kerry G. Baker ◽

Mark W. Parsons

Keyword(s):

Acute Stroke ◽

Upper Limb ◽

Assessment Scale ◽

Motor Assessment

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Use of reliability tested clinically data towards a portable device measurement kit system for upper limb spasticity

Malaysian Journal of Fundamental and Applied Sciences ◽

10.11113/mjfas.v15n4.1493 ◽

2019 ◽

Vol 15 (4) ◽

pp. 622-625

Author(s):

Khairunnisa Johar ◽

Noor Ayuni Che Zakaria ◽

Fazah Akhtar Hanapiah ◽

Low Cheng Yee ◽

Nurul Atiqah Othman ◽

...

Keyword(s):

Upper Limb ◽

Clinical Assessment ◽

Intraclass Correlation ◽

Medical Intervention ◽

Portable Device ◽

Modified Ashworth Scale ◽

The Social ◽

Limb Spasticity ◽

Therapy Sessions ◽

Ashworth Scale

Spasticity refers to the abnormal symptom of having resistance in the joints when patients tried to make a movement. Patients with spasticity need to undergo multiple therapy sessions with medical intervention to ensure that the upper limb achieve maximal function. Modified Ashworth Scale (MAS) is frequently used in clinical assessment with grading on a scale. However, this scale is limited in sensitivity and the accuracy of this evaluation is dependent on the physician’s and therapist’s experience. This study suggests developing a portable measurement device kit system during clinical assessment to reduce inter- and intra-rater variability, and to assist clinicians in making quick clinical evaluation of spasticity. In this study, 19 patients were involved in the data acquisition. Assessment data from upper limb of patients with spasticity were recorded using a Manual Muscle Tester (MMT) and digital goniometer to measure force and the angular motion. During the assessment, patients were examined through slow and fast motion for spasticity evaluation. The collected data were analyzed to study intra-rater reliability value by using Statistical Package for the Social Sciences (SPSS). The results of Intraclass Correlation Coefficient (ICC) values for all patients were in range 0.78 to 0.89. It can be considered that the collected data was reliable and can be used to formulate a model towards the development of a portable device measurement kit system for upper limb spasticity.

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