Muscle tone was tested at the shoulders and wrists of 49 randomly selected poststroke patients with the use of resting joint position (SJP and WJP), resistance to passive movement or stiffness (SRM and WRM), and angle of appearance of resistance (SAR and WAR). Subjects were tested while seated with their arm supported in a suspension sling adapted for free movement. Five of the first and immediately repeated measurement pairs showed strong correlations and interrater reliability (SJP, .839; WJP, .900; SRM, .886; WRM, .904; SAR, .884 [p < .05]). The sixth (WAR) showed moderate reliability (.618, p < .05). Resting joint position measurements were most reliable among subjects with higher tone. The joint first measured had a slight order effect on SRM among subjects with higher muscle tone. Its second measurements were slightly increased over the first among those subjects whose shoulders were measured first and slightly reduced when measured immediately after the wrist. Reliable means of clinical evaluation of muscle tone at the shoulder and wrist are available if the influence of level of tone and the mutual influence of muscles tested are prudently considered.
Patterns of associations among three common clinical muscle tone measures were investigated to determine their degree, and patterns of agreement. Data contributing to selection of clinical measures of muscle tone and understanding factors contributing to occupational dysfunctions were also sought. Forty five persons who were admitted after stroke to two occupational therapy rehabilitation programs were randomly selected. Their affected elbow's resting position (EJP), resistance to passive extension (ERM) and the angle where resistance first appeared (EAR) were measured by one, then a second therapist who also measured voluntary muscle function. Correlations among the three measures were calculated for both administrations and among patient subgroups with statistical correction for multiple correlations. Statistically significant associations appeared between ERM and EAR and between EJP and EAR. Highest statistically significant associations appeared among subjects with poor upper extremity function and those with low muscle tone. Patterns of associations were similar for the first and second administrations at both centres, though patterns among subgroups differed between centres. Correlation patterns suggest that biomechanical factors may influence the joint's resting position (EJP) more than ERM and EAR. Measures may be used interchangeably only with selected patient subgroups, which should also be the basis of method selection.
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