The application of both scales would suggest that confusion exists on their characteristics and limitations as measures of spasticity. Resistance to passive movement is a complex measure that will be influenced by many factors, only one of which could be spasticity. The Ashworth Scale (AS) can be used as an ordinal level measure of resistance to passive movement, but not spasticity. The modified Ashworth Scale (MAS) will need to be treated as a nominal level measure of resistance to passive movement until the ambiguity between the '1' and '1+' grades is resolved. The reliability of the scales is better in the upper limb. The AS may be more reliable than the MAS. There is a need to standardize methods to apply these scales in clinical practice and research.

Background and Purpose-We report the findings of a randomized controlled trial to determine the effectiveness of a multidisciplinary Stroke Education Program (SEP) for patients and their informal carers. Methods-Two hundred four patients admitted with acute stroke and their 176 informal carers were randomized to receive an invitation to the SEP or to receive conventional stroke unit care. The SEP consisted of one 1-hour small group educational session for inpatients followed by six 1-hour sessions after discharge. The primary outcome measure was patient-and carer-perceived health status (SF-36) at 6 months after stroke. Knowledge of stroke, satisfaction with services, emotional outcome, disability, and handicap and were secondary outcome measures. T he need for better information, in addition to greater provision of support, has been voiced by stroke patients and their informal carers. 1 Over 10 years ago, a UK Consensus Statement on the treatment of stroke recommended that stroke patients and their informal carers were entitled to "a clear account of the nature and causes of their stroke. . . and [that] more information rather than less should be given." 2 However, evidence suggests that many patients and carers continue to express a lack of understanding about stroke and its causes, secondary preventative measures, and information about both statutory and informal support. [3][4][5] Information needs of patients and informal carers in hospital and after discharge are not being met, despite the efforts of health services and voluntary agencies. 3,4,6,7 It is not unusual for patients and carers to report that they have not received any information about their illness, despite having had discussions with health professionals and being given written information. Results-OnlyThis could occur for a number of reasons: the information was not retained due to the stress of the situation, was not clear, was too complicated, was too general, or did not address the patient or carer's own issues of concern.A study of stroke patients' and carers' satisfaction with care reported that although 89% were satisfied with their overall care, 49% were dissatisfied with the information they had received while in hospital. 8 These results were mirrored in an audit undertaken at North Tyneside General Hospital in 1996, which found that although only 15% of stroke patients and carers felt dissatisfied with their care in general, 40% of stroke patients and 45% of their informal carers were dissatisfied with the information received about stroke before discharge. In light of these findings, a multidisciplinary group consisting of stroke unit staff, community nurses, and representatives from the Stroke Association and the local voluntary sector developed a Stroke Education Program (SEP) that Received July 9, 1999; final revision received September 13, 1999; accepted September 13, 1999. The aim of the present study was to determine the effectiveness of the Stroke Education Program for improving patients' and carers' perceived health status...

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Background and Purpose-Visual analogue scales (VAS) have been used for the subjective measurement of mood, pain, and health status after stroke. In this study we investigated how stroke-related impairments could alter the ability of subjects to answer accurately. Methods-Consent was obtained from 96 subjects with a clinical stroke (mean age, 72.5 years; 50 men) and 48 control subjects without cerebrovascular disease (mean age, 71.5 years; 29 men). Patients with reduced conscious level or severe dysphasia were excluded. Subjects were asked to rate the tightness that they could feel on the (unaffected) upper arm after 3 low-pressure inflations with a standard sphygmomanometer cuff, which followed a predetermined sequence (20 mm Hg, 40 mm Hg, 0 mm Hg). Immediately after each change, they rated the perceived tightness on 5 scales presented in a random order: 4-point rating scale (none, mild, moderate, severe), 0 to 10 numerical rating scale, mechanical VAS, horizontal VAS, and vertical VAS. Standard tests recorded deficits in language, cognition, and visuospatial awareness. Results-Inability to complete scales with the correct pattern was associated with any stroke (PϽ0.001). There was a significant association between success using scales and milder clinical stroke subtype (PϽ0.01). Within the stroke group, logistic regression analysis identified significant associations (PϽ0.05) between impairments (cognitive and visuospatial) and inability to complete individual scales correctly. Conclusions-Many patients after a stroke are unable to successfully complete self-report measurement scales, including VAS.

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