Interrater and Intrarater Reliability of the Modified Ashworth Scale in Children with Hypertonia

Abstract Background and Purpose. Abnormal muscle tone is a common motor disorder following stroke, which may require rehabilitation. The Modified Ashworth Scale is a 6-point rating scale that is used to measure muscle tone. The interrater and intrarater reliability of measurements obtained with the scale remain equivocal. The purpose of this study was to investigate the reliability of measurements obtained with the scale in the lower limb of patients with stroke. Subjects. Twenty patients were tested 2 weeks after their stroke, and 12 patients were tested 12 weeks after their stroke. Methods. Gastrocnemius, soleus, and quadriceps femoris muscles on the hemiplegic side were tested. Results. Interrater reliability for 2 raters was poor, with a Kendall tau-b correlation for the combined muscle group of .062 (P=.461). For intrarater reliability, the Kendall tau-b correlation was .567 (P<.001). The agreement within one rater occurred mostly on the grade of 0. Discussion and Conclusion. The Modified Ashworth Scale yielded reliable measurements in the lower limb for a single examiner, and agreement was best on the grade of 0. The reliability between examiners was not good, which may bring into question the validity of measurements obtained with the scale.

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Measurement of lower-limb muscle spasticity: Intrarater reliability of Modified Modified Ashworth Scale

The Journal of Rehabilitation Research and Development ◽

10.1682/jrrd.2010.02.0020 ◽

2011 ◽

Vol 48 (1) ◽

pp. 83 ◽

Cited By ~ 52

Author(s):

Nastaran Ghotbi ◽

Noureddin Nakhostin Ansari ◽

Soofia Naghdi ◽

Scott Hasson

Keyword(s):

Lower Limb ◽

Lower Limb Muscle ◽

Limb Muscle ◽

Intrarater Reliability ◽

Muscle Spasticity ◽

Modified Ashworth Scale ◽

Ashworth Scale

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

Archives of Physical Medicine and Rehabilitation ◽

10.1053/apmr.2002.35474 ◽

2002 ◽

Vol 83 (10) ◽

pp. 1349-1354 ◽

Cited By ~ 131

Author(s):

Allison Brashear ◽

Ross Zafonte ◽

Michael Corcoran ◽

Nestor Galvez-Jimenez ◽

Jean-Michel Gracies ◽

...

Keyword(s):

Upper Limb ◽

Assessment Scale ◽

Disability Assessment ◽

Intrarater Reliability ◽

Ashworth Scale

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Assessing Motor Deficits in Neurological Rehabilitation: Patterns of Instrument Usage

Neurorehabilitation and Neural Repair ◽

10.1177/154596830101500104 ◽

2001 ◽

Vol 15 (1) ◽

pp. 23-30 ◽

Cited By ~ 56

Author(s):

Frederike M.J. van Wijck ◽

Anand D. Pandyan ◽

Garth R Johnson ◽

Michael P. Barnes

Keyword(s):

Assessment Tools ◽

Motor Deficits ◽

Measurement Technology ◽

Neurological Rehabilitation ◽

Clinical Scales ◽

Frequent Use ◽

Modified Ashworth Scale ◽

Use Of Assessment ◽

Assessment Scales ◽

Ashworth Scale

To describe current patterns in the use of clinical scales and measurement tech nology for the assessment of motor deficits in neurological rehabilitation. Question naire, sent to the 2,556 members of the World Forum for Neurological Rehabilita tion, distributed over 75 countries. Sixty-eight questionnaires were returned. Generally, participants indicated that the centres where they were based used a num ber of different clinical assessment scales (median, three), most frequently with a small proportion of patients. The (Modified) Ashworth Scale, the FIM, and the Fugl-Meyer were used most frequently. Only 35 respondents stated that their centre used one or more scales in >75% of their patients, but the choice of such routinely applied in struments varied between centres. The application of measurement technology was re stricted, with video and goniometry being used most frequently. The main barriers to more frequent use of assessment tools were perceived to be a lack of resources, infor mation, and training. The (albeit limited) results from this survey suggest that the assessment of motor deficits in neurological rehabilitation is currently mostly qualita tive and lacks standardisation. More resources and education are required to support a more routine application of assessment tools and to integrate measurement tech nology further in neurological rehabilitation to assist in the process of quantification of outcomes. Key Words: Motor deficits—Neurological rehabilitation—Outcome as sessment—Standardisation—Measurement technology.

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Interrater reliability of the Modified Modified Ashworth Scale (MMAS) for patients with wrist flexor muscle spasticity

Physiotherapy Theory and Practice ◽

10.1080/09593980802278959 ◽

2008 ◽

Vol 24 (5) ◽

pp. 372-379 ◽

Cited By ~ 32

Author(s):

Soofia Naghdi ◽

Noureddin Nakhostin Ansari ◽

Somayye Azarnia ◽

Anoushiravan Kazemnejad

Keyword(s):

Interrater Reliability ◽

Flexor Muscle ◽

Muscle Spasticity ◽

Wrist Flexor ◽

Modified Ashworth Scale ◽

Ashworth Scale

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Functional electrical stimulation for equine epaxial muscle spasms: retrospective study of 241 clinical cases

Comparative Exercise Physiology ◽

10.3920/cep13031 ◽

2014 ◽

Vol 10 (2) ◽

pp. 89-97 ◽

Cited By ~ 6

Author(s):

S.J. Schils ◽

T.A. Turner

Keyword(s):

Electrical Stimulation ◽

Retrospective Study ◽

Functional Electrical Stimulation ◽

Sustained Improvement ◽

Modified Ashworth Scale ◽

Muscle Spasms ◽

Ashworth Scale ◽

Epaxial Muscle ◽

Clinical Cases

A retrospective study of 241 clinical cases, utilising over 1,800 functional electrical stimulation (FES) treatments to alleviate epaxial muscle spasms, showed that almost 80% (191) of the horses had a 1-grade improvement in muscle spasms after 2 FES treatments, based on the Modified Ashworth Scale adapted to horses. In addition, 60% (142) of these horses showed a sustained improvement for a minimum of 2 months.

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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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