Modified Ashworth Scale (MAS) Model based on Clinical Data Measurement towards Quantitative Evaluation of Upper Limb Spasticity

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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Inter-Rater and Intra-Rater Reliability of Quantitative Upper Limb Spasticity Evaluation based on Modified Ashworth Scale Tool

2018 IEEE-EMBS Conference on Biomedical Engineering and Sciences (IECBES) ◽

10.1109/iecbes.2018.8626688 ◽

2018 ◽

Author(s):

Asmarani Ahmad Puzi ◽

Shahrul Naim Sidek ◽

Ismail Mohd Khairuddin ◽

Hazlina Md. Yusof ◽

Hadi Mat Rosly

Keyword(s):

Upper Limb ◽

Rater Reliability ◽

Modified Ashworth Scale ◽

Limb Spasticity ◽

Ashworth Scale

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Safety and efficacy of letibotulinumtoxinA(BOTULAX®) in treatment of post stroke upper limb spasticity: a randomized, double blind, multi-center, phase III clinical trial

Clinical Rehabilitation ◽

10.1177/0269215516689331 ◽

2017 ◽

Vol 31 (9) ◽

pp. 1179-1188 ◽

Cited By ~ 3

Author(s):

Kyung Hee Do ◽

Min Ho Chun ◽

Nam-Jong Paik ◽

Yoon Ghil Park ◽

Shi-Uk Lee ◽

...

Keyword(s):

Upper Limb ◽

Botulinum Neurotoxin ◽

Primary Outcome ◽

Secondary Outcome ◽

Safety Measures ◽

Modified Ashworth Scale ◽

Burden Scale ◽

Limb Spasticity ◽

Ashworth Scale ◽

Wrist Flexors

Objective: To investigate a new botulinum neurotoxin type A, termed letibotulinumtoxinA(Botulax®) and compare its efficacy and safety for post-stroke upper limb spasticity with that of onabotulinumtoxinA(Botox®). Design: A prospective, double-blinded, multicenter, randomized controlled clinical study. Setting: Six university hospitals in Korea. Subjects: A total of 187 stroke participants with upper limb spasticity. Interventions: Two kinds of botulinum neurotoxin type A were used. One set of injection was performed and total injected doses were 309.21±62.48U(Botulax) and 312.64±49.99U(Botox)( P>0.05). Main measures: Primary outcome was measured using the modified Ashworth scale for wrist flexors at week 4 and secondary outcome was measured using modified Ashworth scale for wrist flexors, elbow flexors, finger flexors, and thumb flexors as well as Global Assessment in spasticity, Disability Assessment Scale, and Caregiver Burden Scale. Safety measures including adverse events, vital signs and physical examination, and laboratory tests were also monitored. Results: The mean ages for the Botulax group were 56.81±9.49 and which for the Botox group were 56.93±11.93( P>0.05). In primary outcome, the change in modified Ashworth scale for wrist flexors was -1.45±0.61 in the Botulax group and -1.40±0.57 in the Botox group, and the difference between the two groups was -0.06(95% CI:-0.23–0.12, P>0.05). In secondary outcome, both groups demonstrated significant improvements with respect to modified Ashworth scale, Global Assessment in spasticity, Disability Assessment Scale, and Caregiver Burden Scale ( P<0.05), and no significant difference was observed between the two groups ( P>0.05). In addition, safety measures showed no significant differences between the two groups ( P>0.05). Conclusions: The efficacy and safety of Botulax were comparable with those of Botox in treatment of post-stoke upper limb spasticity.

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Association between Severe Upper Limb Spasticity and Brain Lesion Location in Stroke Patients

BioMed Research International ◽

10.1155/2014/162754 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 20

Author(s):

Alessandro Picelli ◽

Stefano Tamburin ◽

Francesca Gajofatto ◽

Giampietro Zanette ◽

Marialuigia Praitano ◽

...

Keyword(s):

White Matter ◽

Upper Limb ◽

Brain Lesion ◽

Mapping Method ◽

Thalamic Nuclei ◽

Stroke Patients ◽

Lesion Location ◽

Modified Ashworth Scale ◽

Limb Spasticity ◽

Ashworth Scale

Association between the site of brain injury and poststroke spasticity is poorly understood. The present study investigated whether lesion analysis could document brain regions associated with the development of severe upper limb poststroke spasticity. A retrospective analysis was conducted on 39 chronic stroke patients. Spasticity was assessed at the affected upper limb with the modified Ashworth scale (shoulder, elbow, wrist, and fingers). Brain lesions were traced from magnetic resonance imaging performed within the first 7 days after stroke and region of interest images were generated. The association between severe upper limb spasticity (modified Ashworth scale ≥2) and lesion location was determined with the voxel-based lesion-symptom mapping method implemented in MRIcro software. Colored maps representing thezstatistics were generated and overlaid onto the automated anatomical labeling and the Johns Hopkins University white matter templates provided with MRIcron. Thalamic nuclei were identified with the Talairach Daemon software. Injuries to the insula, the thalamus, the basal ganglia, and white matter tracts (internal capsule, corona radiata, external capsule, and superior longitudinal fasciculus) were significantly associated with severe upper limb poststroke spasticity. Further advances in our understanding of the neural correlates of spasticity may lead to early targeted rehabilitation when key regions are damaged.

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Upper Limb Motor Function Affects the Outcome after Treatment with Botulinum Toxin A

European Neurology ◽

10.1159/000499907 ◽

2019 ◽

Vol 81 (1-2) ◽

pp. 30-36 ◽

Cited By ~ 1

Author(s):

Kenta Fujimura ◽

Hitoshi Kagaya ◽

Hisae Onaka ◽

Nao Nagasawa ◽

Akihito Ishihara ◽

...

Keyword(s):

Motor Function ◽

Upper Limb ◽

Botulinum Toxin A ◽

Lower Score ◽

Disability Assessment ◽

Limb Position ◽

Modified Ashworth Scale ◽

Limb Spasticity ◽

The Mean ◽

Ashworth Scale

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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Data-Driven Model for Upper Limb Spasticity Detection

International Journal of Integrated Engineering ◽

10.30880/ijie.2021.13.04.017 ◽

2021 ◽

Vol 13 (4) ◽

Author(s):

Jingye Yee ◽

◽

Cheng Yee Low ◽

Natiara Mohamad Hashim ◽

Fazah Akhtar Hanapiah ◽

...

Keyword(s):

Upper Limb ◽

Structural Damage ◽

Data Driven ◽

Modified Ashworth Scale ◽

The Central Nervous System ◽

Limb Spasticity ◽

Objective Value ◽

Brain And Spinal Cord ◽

Ashworth Scale ◽

Machine Learning Models

Upper limb spasticity (ULS) is a common pathophysiological changes manifest by a structural damage towards the central nervous system (CNS) that includes brain and spinal cord. The current clinical practice of spasticity assessment utilizes Modified Ashworth Scale (MAS) as a subjective tool to measure the severity of spasticity. Lack of objective value, poor sensitivity in detecting minimal changes, and dependency to the interpretation by the assessing clinicians are the several reasons of the inter and intra-rater variability of the measurement using MAS. These limit the use of MAS in diagnosing, treating, and monitoring spasticity especially in inexperienced clinicians, hence leading to inadequate spasticity management. To overcome this problem, a study is carried out to quantify and develop a data-driven model of ULS detection based on MAS. The characteristics that detect the existence of ULS according to MAS are identified and adopted to train the machine learning models for smart diagnosis purpose to assist the physicians to effectively manage spasticity.

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Optimisation of Composite Briquette Made From Sawdust / Rice Husk Using Starch and Clay Binder

International Journal of Integrated Engineering ◽

10.30880/ijie.2021.13.04.019 ◽

2021 ◽

Vol 13 (4) ◽

Author(s):

Chukwuneke J. L. ◽

◽

Umeji A. C. ◽

Obika E. N. ◽

Fakiyesi O. B ◽

...

Keyword(s):

Structural Damage ◽

Data Driven ◽

Current Clinical Practice ◽

Modified Ashworth Scale ◽

The Central Nervous System ◽

Limb Spasticity ◽

Objective Value ◽

Brain And Spinal Cord ◽

Ashworth Scale ◽

Machine Learning Models

Upper limb spasticity (ULS) is a common pathophysiological changes manifest by a structural damage towards the central nervous system (CNS) that includes brain and spinal cord. The current clinical practice of spasticity assessment utilizes Modified Ashworth Scale (MAS) as a subjective tool to measure the severity of spasticity. Lack of objective value, poor sensitivity in detecting minimal changes, and dependency to the interpretation by the assessing clinicians are the several reasons of the inter and intra-rater variability of the measurement using MAS. These limit the use of MAS in diagnosing, treating, and monitoring spasticity especially in inexperienced clinicians, hence leading to inadequate spasticity management. To overcome this problem, a study is carried out to quantify and develop a data-driven model of ULS detection based on MAS. The characteristics that detect the existence of ULS according to MAS are identified and adopted to train the machine learning models for smart diagnosis purpose to assist the physicians to effectively manage spasticity.

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