Development of Simple Measurement Device to Measure Spasticity Based on an Analysis of Clinical Maneuver and Its Concurrent Validity With Modified Ashworth Scale

Abstract BackgroundDespite recent developments in the methodology for measuring spasticity, the discriminative capacity of clinically diagnosed spasticity has not been well established. This study aimed to develop a simple device for measuring velocity-dependent spasticity with improved discriminative capacity based on an analysis of clinical maneuver and to examine its reliability and validity.MethodsThis study consisted of three experiments. First, to determine the appropriate motion of a mechanical device for the measurement of velocity-dependent spasticity, the movement pattern and the angular velocity that the clinicians use in evaluating velocity-dependent spasticity were investigated. Analysis of the procedures performed by six physical therapists in evaluating spasticity were conducted using an electrogoniometer. Second, a device for measuring the resistance force against ankle dorsiflexion was developed based on the investigation in the first experiment. Additionally, preliminary testing of validity, as compared to that of the Modified Ashworth Scale (MAS), was conducted on 17 healthy participants and 10 patients who had stroke with spasticity. Third, the reliability of measurement and the concurrent validity of mechanical measurement in the best ankle velocity setting were further tested in a larger sample comprising 24 healthy participants and 32 patients with stroke.ResultsThe average angular velocity used by physical therapists to assess spasticity was 268±77°/s. A device that enabled the measurement of resistance force at velocities of 300°/s, 150°/s, 100°/s, and 5°/s was developed. Based on the analysis of clinical procedures, a stretching motion prior to measurement was added. In the measurement, an angular velocity of 300°/s was found to best distinguish patients with spasticity (MAS of 1+ and 2) from healthy individuals. A measurement of 300°/s in the larger sample differentiated the control group from the MAS 1, 1+, and 2 subgroups (p<0.01), as well as the MAS 1 and 2 subgroups (p<0.05). No fixed or proportional bias was observed in repeated measurements.ConclusionsA simple mechanical measurement device was developed based on the analysis of clinical maneuver for measuring spasticity and was shown to be valid in differentiating the existence and extent of spasticity.Trial registrationUMIN000026305, date of registration: 25 February 2017; jRCTs042180044, date of registration: 21 November 2018; UMIN000040472, date of registration: 21 May 2020.

Download Full-text

3. The Inter-rater Variability and Reliability of the use of the Modified Ashworth Scale for the Upper Motor Neuron Syndrome

Inquiry@Queen's Undergraduate Research Conference Proceedings ◽

10.24908/iqurcp.9858 ◽

2018 ◽

Author(s):

Basia Gwardjan

Keyword(s):

Physical Therapists ◽

Treatment Options ◽

Quantitative Measure ◽

Occupational Therapists ◽

Management Program ◽

Improvement Project ◽

Modified Ashworth Scale ◽

Cord Injury ◽

Rater Variability ◽

Ashworth Scale

This poster reports on the results of a quality improvement project. The objective was to determine the inter-rater variability and reliability of the Modified Ashworth Scale for assessing spasticity in people with traumatic brain injury.Hamilton Health Sciences operates the comprehensive spasticity management program. In this regional program, the MAS is used by physical therapists, occupational therapists and physicians as a quantitative measure of spasticity. The MAS is used to make determinations related to treatment options as well as follow the efficacy of treatment.The participants were 28 practitioners from the disciplines of medicine, physical therapy and occupational therapy. Each practitioner was provided an explicit set of written instructions and then asked to examine two patients with traumatic spinal cord injury. The MAS scores were reported anonymously. As well, the two patients were assigned MAS scores by two expert spasticity management clinicians.There was substantial inter-rater variability with MAS scores. Fleiss' Generalized Kappa, which is chance-corrected measure of agreement among three or more raters, was 0.18. This is interpreted as poor agreement. Furthermore, only 46 percent of the participants agreed with the MAS scores assigned by the physician expert in the first subject and 50 percent of the participants agreed with the MAS scores assigned by the physician expert in the second subject.Clinicians should be cognizant of the variability of the MAS when making determinations related to patient management.

Download Full-text

High concurrent validity between digital and analogue algometers to measure pressure pain thresholds in healthy participants and people with migraine: a cross-sectional study

The Journal of Headache and Pain ◽

10.1186/s10194-021-01278-8 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

René F. Castien ◽

Michel W. Coppieters ◽

Tom S. C. Durge ◽

Gwendolyne G. M. Scholten-Peeters

Keyword(s):

Concurrent Validity ◽

Tibialis Anterior Muscle ◽

Intraclass Correlation ◽

Cephalic Region ◽

Limits Of Agreement ◽

Temporal Muscle ◽

Pain Thresholds ◽

Pressure Pain ◽

Pressure Pain Thresholds ◽

Healthy Participants

Abstract Background Pressure pain thresholds (PPTs) are commonly assessed to quantify mechanical sensitivity in various conditions, including migraine. Digital and analogue algometers are used, but the concurrent validity between these algometers is unknown. Therefore, we assessed the concurrent validity between a digital and analogue algometer to determine PPTs in healthy participants and people with migraine. Methods Twenty-six healthy participants and twenty-nine people with migraine participated in the study. PPTs were measured interictally and bilaterally at the cephalic region (temporal muscle, C1 paraspinal muscles, and trapezius muscle) and extra-cephalic region (extensor carpi radialis muscle and tibialis anterior muscle). PPTs were first determined with a digital algometer, followed by an analogue algometer. Intraclass correlation coefficients (ICC3.1) and limits of agreement were calculated to quantify concurrent validity. Results The concurrent validity between algometers in both groups was moderate to excellent (ICC3.1 ranged from 0.82 to 0.99, with 95%CI: 0.65 to 0.99). Although PPTs measured with the analogue algometer were higher at most locations in both groups (p < 0.05), the mean differences between both devices were less than 18.3 kPa. The variation in methods, such as a hand-held switch (digital algometer) versus verbal commands (analogue algometer) to indicate when the threshold was reached, may explain these differences in scores. The limits of agreement varied per location and between healthy participants and people with migraine. Conclusion The concurrent validity between the digital and analogue algometer is excellent in healthy participants and moderate in people with migraine. Both types of algometer are well-suited for research and clinical practice but are not exchangeable within a study or patient follow-up.

Download Full-text

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.

Download Full-text

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

Download Full-text

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.

Download Full-text

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.

Download Full-text

Inter-rater reliability of the Modified Modified Ashworth Scale as a clinical tool in measurements of post-stroke elbow flexor spasticity

Neurorehabilitation ◽

10.3233/nre-2009-0472 ◽

2009 ◽

Vol 24 (3) ◽

pp. 225-229 ◽

Cited By ~ 12

Author(s):

Noureddin Nakhostin Ansari ◽

Soofia Naghdi ◽

Scott Hasson ◽

Atefeh Mousakhani ◽

Azam Nouriyan ◽

...

Keyword(s):

Elbow Flexor ◽

Clinical Tool ◽

Rater Reliability ◽

Post Stroke ◽

Modified Ashworth Scale ◽

Ashworth Scale

Download Full-text

Can the use of proprioceptive knee braces have implications in the management of osteoarthritic knees: An exploratory study

Prosthetics and Orthotics International ◽

10.1177/0309364618796852 ◽

2018 ◽

Vol 43 (2) ◽

pp. 140-147 ◽

Cited By ~ 1

Author(s):

Tariq A Kwaees ◽

Jim Richards ◽

Gill Rawlinson ◽

Charalambos Panayiotou Charalambous ◽

Ambreen Chohan

Keyword(s):

Angular Velocity ◽

Knee Osteoarthritis ◽

Internal Rotation ◽

Lower Limb ◽

Knee Injury ◽

Neuromuscular Control ◽

Outcome Score ◽

Knee Braces ◽

Step Down ◽

Healthy Participants

Background: Use of proprioceptive knee braces to control symptomology by altering neuromuscular control mechanisms has been shown in patellofemoral pain. Although their potential in patients with knee osteoarthritis is vast, little research has examined their efficacy. Objectives: This study examines the effect of a proprioceptive knee brace on lower limb kinematics and kinetics in healthy participants and in participants with OA. Methods: Thirteen healthy participants were asked to perform a 10-cm step-down task with and without a proprioceptive brace. Data were collected using a 10-camera Qualisys system. Individuals with osteoarthritis completed the Knee injury and Osteoarthritis Outcome Score before and after 4 weeks of intervention. Results: During step-down reductions in knee maximum internal rotation, transverse range of movement, transverse plane angular velocity and maximum internal rotation angular velocity was seen. Ankle plantar flexion and inversion angular velocity decreased while inversion and maximum supination angular velocity increased. Improvements in Knee injury and Osteoarthritis Outcome Score were noted across all parameters with brace use. Conclusion: Positive changes in kinematic variables in multiple planes can be achieved with proprioceptive bracing alongside improved patient outcome. These changes occur at the knee but analysis of other weight bearing joints should not be overlooked in future studies. This study supports the concept of neuromuscular reinforcement and re-education through proprioceptive bracing and its application in the management in knee osteoarthritis. Clinical relevance Proprioception can alter symptoms and biomechanics embraced and adjacent lower limb joints. The results of this study highlights the potential uses of non-mechanical bracing in the treatment of osteoarthritis and other potential to bridge the osteoarthritis treatment gap. Furthermore, large-scale research is needed to match disease subset to brace type.

Download Full-text