Study design: Observational study. Objectives: To report the intra-rater (one rater), inter-rater (two raters) and inter-session (one subject, sessions 1-5) reliability of lower extremity modified Ashworth scale (MAS) scores among patients with chronic spinal cord injury (SCI). Setting: Tertiary Academic Rehab Centre in Toronto, Canada. Methods: MAS scores of 20 subjects with chronic SCI (C5-T10 AIS A-D412 months) were recorded for the hip abductors and adductors, knee flexors and extensors, and ankle plantar and dorsiflexors. MAS scores were assessed by two blinded raters (A and B) at the same time of day, weekly for 5 weeks using standardized test positions, a one-cycle per second metronome, with ratings recorded on the second cycle. MAS score reproducibility [intra-rater, inter-rater] were calculated using Cohen's Kappa. Intraclass correlation coefficients (ICCs) were calculated to determine inter-session (trials 1-5) reliability; Kappa values X0.81 and ICC values X0.75 were desired. Results: Intra-rater reliability was fair to almost perfect (0.2oko1.0) and differed between raters. Inter-rater reliability was poor-to-moderate (ko0.6) for all muscle groups. Inter-session reliability for a single rater was fair-to-good (0.4oICCo0.75) for all muscle groups. Conclusions: MAS was not reliable as an intra-rater tool for all raters, and showed poor inter-rater and modest inter-session reliability. MAS has inadequate reliability for determining lower extremity spasticity between raters (inter-rater) or over time (inter-session). It is recommended that the rehabilitation science community seek alternative measures for quantifying spasticity.
Background:To date, a postural perturbation system capable of generating position-, velocity-, and force-controlled perturbations while being portable and suitable for use during various postural scenarios does not exist. Therefore, the purpose of the present study was to design, develop, and test a portable and automated postural perturbation system (PAPPS) that can be used to measure and train postural reactions during sitting, standing, and treadmill walking. Method of Approach:The core component of the PAPPS was a linear actuator that provides horizontal perturbations. The actuator could generate arbitrary displacement, velocity, or force perturbations as a function of time. In addition, the PAPPS was able to measure the actuator's displacement, velocity, and load, which could be used to study postural perturbation responses. The height at which the PAPPS was delivering the perturbations could be easily adjusted to allow for different subject/patient anthropometrics and a wide range of postural scenarios such as sitting, standing, and treadmill walking. The PAPPS generated a peak displacement of 0.6 m, a peak velocity of 0.5 m/s, and a peak force of 600 N, which is more than sufficient to elicit high intensity postural perturbations.Multiple and nested safety circuits have been implemented into the PAPPS to ensure the safety of the subjects/patients during experiments and/or training.To evaluate the accuracy and repeatability of the PAPPS during position-, velocityand force-controlled perturbations, experiments were conducted using sinusoidal, impulse and ramp profiles as a function of time. Highly sensitive displacement and force sensors that were external to the PAPPS were used to determine the accuracy and repeatability of the proposed device. In addition, a case study was performed to demonstrate the A Portable and Automated Postural Perturbation System for Balance Assessment, Training, and Neuromuscular System Identification MED_08_1012_final Vette 3 performance of the PAPPS during pseudorandom sinusoidal perturbations that were applied to a healthy individual during sitting. Results and Conclusions: The accuracy and repeatability tests suggest that the PAPPS can generate reliable and high-precision displacement, velocity, and force perturbations.Potential applications of this system include, but are not limited to: (1) studies of postural response to various perturbation types and profiles in diverse subject populations during sitting, standing, and treadmill walking, and (2) training of postural balance in diverse patient populations during sitting, standing, and treadmill walking.
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