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

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.

scholarly journals Use of Surface EMG in Clinical Rehabilitation of Individuals With SCI: Barriers and Future Considerations

2020 ◽  
Vol 11 ◽  
Author(s):  
Rakesh Pilkar ◽  
Kamyar Momeni ◽  
Arvind Ramanujam ◽  
Manikandan Ravi ◽  
Erica Garbarini ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Clinical Education ◽  
Physical Therapists ◽  
Occupational Therapists ◽  
Surface Emg ◽  
Cord Injury ◽  
Knowledge Share ◽  
Hands On ◽  
Intuitive Interfaces ◽  
User Friendly

Surface electromyography (sEMG) is a widely used technology in rehabilitation research and provides quantifiable information on the myoelectric output of a muscle. In this perspective, we discuss the barriers which have restricted the wide-spread use of sEMG in clinical rehabilitation of individuals with spinal cord injury (SCI). One of the major obstacles is integrating the time-consuming aspects of sEMG in the already demanding schedule of physical therapists, occupational therapists, and other clinicians. From the clinicians' perspective, the lack of confidence to use sEMG technology is also apparent due to their limited exposure to the sEMG technology and possibly limited mathematical foundation through educational and professional curricula. Several technical challenges include the limited technology-transfer of ever-evolving knowledge from sEMG research into the off-the-shelf EMG systems, lack of demand from the clinicians for systems with advanced features, lack of user-friendly intuitive interfaces, and the need for a multidisciplinary approach for accurate handling and interpretation of data. We also discuss the challenges in the application and interpretation of sEMG that are specific to SCI, which are characterized by non-standardized approaches in recording and interpretation of EMGs due to the physiological and structural state of the spinal cord. Addressing the current barriers will require a collaborative, interdisciplinary, and unified approach. The most relevant steps could include enhancing user-experience for students pursuing clinical education through revised curricula through sEMG-based case studies/projects, hands-on involvement in the research, and formation of a common platform for clinicians and technicians for self-education and knowledge share.

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

2021 ◽  
Author(s):  
Hiroki Tanikawa ◽  
Masahiko Mukaino ◽  
Shota Itoh ◽  
Hikaru Kondoh ◽  
Kenta Fujimura ◽  
...  
Keyword(s):  
Angular Velocity ◽  
Concurrent Validity ◽  
Physical Therapists ◽  
Resistance Force ◽  
Mechanical Measurement ◽  
Measurement Device ◽  
Modified Ashworth Scale ◽  
Ashworth Scale ◽  
Larger Sample ◽  
Healthy Participants

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.

scholarly journals Bilateral and asymmetrical contributions of passive and active ankle plantar flexors stiffness to spasticity in humans with spinal cord injury

2020 ◽  
Vol 124 (3) ◽  
pp. 973-984
Author(s):  
Bing Chen ◽  
Sina Sangari ◽  
Jakob Lorentzen ◽  
Jens B. Nielsen ◽  
Monica A. Perez
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Reflex ◽  
Plantar Flexors ◽  
Muscle Properties ◽  
Clinical Assessments ◽  
Modified Ashworth Scale ◽  
Cord Injury ◽  
Ashworth Scale ◽  
Passive Muscle

Spasticity affects a number of people with spinal cord injury (SCI). Using biomechanical, electrophysiological, and clinical assessments, we found that passive muscle properties and active spinal reflex mechanisms contribute bilaterally and asymmetrically to spasticity in ankle plantarflexor muscles in humans with chronic SCI. A self-reported questionnaire had poor agreement with the Modified Ashworth Scale in detecting asymmetries in spasticity. The nature of these changes might contribute to the poor sensitivity of clinical exams.

scholarly journals Modified Ashworth scale and spasm frequency score in spinal cord injury: reliability and correlation

Spinal Cord ◽  
2016 ◽  
Vol 54 (9) ◽  
pp. 702-708 ◽  
Author(s):  
C B Baunsgaard ◽  
U V Nissen ◽  
K B Christensen ◽  
F Biering-Sørensen
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Modified Ashworth Scale ◽  
Cord Injury ◽  
Ashworth Scale ◽  
Frequency Score

scholarly journals A group-delivered self-management program reduces spasticity in people with multiple sclerosis: A randomized, controlled pilot trial

2017 ◽  
Vol 3 (1) ◽  
pp. 205521731769999 ◽  
Author(s):  
Cinda L Hugos ◽  
Dennis Bourdette ◽  
Yiyi Chen ◽  
Zunqiu Chen ◽  
Michelle Cameron
Keyword(s):  
Multiple Sclerosis ◽  
Pilot Trial ◽  
Management Program ◽  
Group Instruction ◽  
Impact Scale ◽  
Modified Ashworth Scale ◽  
Fatigue Impact Scale ◽  
Clinically Significant ◽  
Ashworth Scale

Background Spasticity affects more than 80% of people with multiple sclerosis (MS), affecting activity, participation, and quality of life. Based on an international guideline, an MS spasticity group education and stretching program, MS Spasticity: Take Control (STC), has been developed. Objective The objective of this paper is to determine whether STC with home stretching is associated with greater changes in spasticity than usual care (UC), consisting of an illustrated stretching booklet and home stretching but without group instruction or support, in people with MS. Methods Ambulatory MS patients with self-reported spasticity interfering with daily activities were randomized to STC or UC. Individuals completed questionnaires regarding MS, spasticity, walking, fatigue and mood, and physical measures of spasticity and walking. Results Thirty-eight of 40 participants completed both assessments. Mean total score and scores on two subscales of the MS Spasticity Scale-88 improved more with STC than with UC ( p < 0.03). There was no significant change in the Modified Ashworth Scale in either group. Mean scores on the Modified Fatigue Impact Scale, the Beck Depression Inventory-II, and the physical component of the Multiple Sclerosis Impact Scale-29 showed statistically and clinically significant improvements in the STC group only. Conclusions Participation in STC improved self-reported impact of spasticity more than UC and provided encouraging improvements in other measures.

A comparative evaluation of telehealth and direct assessment when screening for spasticity in residents of two long-term care facilities

2020 ◽  
pp. 026921552096384
Author(s):  
Kelly A Harper ◽  
Emily C Butler ◽  
Mallory L Hacker ◽  
Aaditi Naik ◽  
Bryan R Eoff ◽  
...  
Keyword(s):  
Long Term Care ◽  
Screening Tool ◽  
Reference Standard ◽  
Operating Characteristics ◽  
Term Care ◽  
Modified Ashworth Scale ◽  
Cord Injury ◽  
Care Facilities ◽  
Ashworth Scale

Objective: To evaluate the performance of telehealth as a screening tool for spasticity compared to direct patient assessment in the long-term care setting. Design: Cross-sectional, observational study. Setting: Two long-term care facilities: a 140-bed veterans’ home and a 44-bed state home for individuals with intellectual and developmental disabilities. Subjects: Sixty-one adult residents of two long-term care facilities (aged 70.1 ± 16.2 years) were included in this analysis. Spasticity was identified in 43% of subjects (Modified Ashworth Scale rating mode = 2). Contributing diagnoses included traumatic brain injury, spinal cord injury, birth trauma, stroke, cerebral palsy, and multiple sclerosis. Main measures: Movement disorders neurologists conducted in-person examinations to determine whether spasticity was present (reference standard) and also evaluated subjects with spasticity using the Modified Ashworth Scale. Telehealth screening examinations, facilitated by a bedside nurse, were conducted remotely by two teleneurologists using a three-question screening tool. Telehealth screening determinations of spasticity were compared to the reference standard determination to calculate sensitivity, specificity, and the area under the curve (AUC) in receiver operating characteristics. Teleneurologist agreement was evaluated using Cohen’s kappa. Results: Teleneurologist 1 had a specificity of 89% and sensitivity of 65% to identify the likely presence of spasticity ( n = 61; AUC = 0.770). Teleneurologist 2 showed 100% specificity and 82% sensitivity ( n = 16; AUC = 0.909). There was almost perfect agreement between the two examiners at 94% (kappa = 0.875, 95% CI: 0.640–1.000). Conclusion: Telehealth may provide a useful, efficient method of identifying residents of long-term care facilities that likely need referral for spasticity evaluation.

scholarly journals Views about sensory modulation from people with schizophrenia and treating staff: A multisite qualitative study

2021 ◽  
pp. 030802262098847
Author(s):  
Tawanda Machingura ◽  
Chris Lloyd ◽  
Karen Murphy ◽  
Sarah Goulder ◽  
David Shum ◽  
...  
Keyword(s):  
Content Analysis ◽  
Treatment Option ◽  
Perceived Risk ◽  
Quantitative Methods ◽  
Qualitative Content Analysis ◽  
Treatment Options ◽  
Occupational Therapists ◽  
Sensory Modulation ◽  
Structured Interviews ◽  
Effective Training

Introduction Current non-pharmacological treatment options for people with schizophrenia are limited. There is, however, emerging evidence that sensory modulation can be beneficial for this population. This study aimed to gain insight into sensory modulation from the user’s and the treating staff’s perspectives. Method A qualitative content analysis design was used. Transcripts from occupational therapists ( n=11) and patients with schizophrenia ( n=13) derived from in-depth semi-structured interviews were analysed for themes using content analysis. Results Five themes emerged from this study: Service user education on the sensory approach is the key; A variety of tools should be tried; Sensory modulation provides a valued treatment option; There are challenges of managing perceived risk at an organisational level; and There is a shortage of accessible and effective training. Conclusion People with schizophrenia and treating staff had congruent perceptions regarding the use of sensory modulation as a treatment option. The findings suggest that sensory modulation can be a valued addition to treatment options for people with schizophrenia. We suggest further research on sensory modulation intervention effectiveness using quantitative methods so these results can be further explored.

“Proximalization is Advancement”—Zone 3 Frozen Elephant Trunk vs Zone 2 Frozen Elephant Trunk: A Literature Review

2021 ◽  
pp. 153857442110024
Author(s):  
Rozina Yasmin Choudhury ◽  
Kamran Basharat ◽  
Syeda Anum Zahra ◽  
Tien Tran ◽  
Lara Rimmer ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Surgical Treatment ◽  
Literature Review ◽  
Treatment Options ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Descending Aorta ◽  
Cord Injury ◽  
Aortic Pathologies

Over the decades, the Frozen Elephant Trunk (FET) technique has gained immense popularity allowing simplified treatment of complex aortic pathologies. FET is frequently used to treat aortic conditions involving the distal aortic arch and the proximal descending aorta in a single stage. Surgical preference has recently changed from FET procedures being performed at Zone 3 to Zone 2. There are several advantages of Zone 2 FET over Zone 3 FET including reduction in spinal cord injury, visceral ischemia, neurological and cardiovascular sequelae. In addition, Zone 2 FET is a technically less complicated procedure. Literature on the comparison between Zone 3 and Zone 2 FET is scarce and primarily observational and anecdotal. Therefore, further research is warranted in this paradigm to substantiate current surgical treatment options for complex aortic pathologies. In this review, we explore literature surrounding FET and the reasons for the shift in surgical preference from Zone 3 to Zone 2.

Sign in / Sign up

Export Citation Format

Share Document