A biomechanical investigation into the validity of the modified Ashworth Scale as a measure of elbow spasticity

Pandyan, Anand; Price, Chris; Barnes, Michael P.; Johnson, Garth

doi:10.1191/0269215503cr610oa

Cited by 135 publications

(93 citation statements)

References 10 publications

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“…These last two arguments are also indirectly supported by the poor correlation between MAS and biomechanical measures documented in previous studies. 30,31 Most of the reported MAS values were 0, 1 and 1+ (~80%, Figure 2). By regarding MAS a nominal scale, only exact agreement will be captured as agreement between raters, as simple kappa is blind to off-diagonal association, when more than two categories exist.…”

Section: Discussionmentioning

confidence: 98%

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

2016

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Study design: Intra-and inter-rater reliability study. Objectives: To assess intra-and inter-rater reliability of the Modified Ashworth Scale (MAS) and Spasm Frequency Score (SFS) in lower extremities in a population of spinal cord-injured persons, as well as correlations between the two scales. Setting: Clinic for Spinal Cord Injuries, Rigshospitalet, Hornbaek, Denmark. Methods: Thirty-one persons participated in the study and were tested four times in total with MAS and SFS by three experienced raters. Cohen's kappa (κ), simple and quadratic weighted (nominal and ordinal scale level of measurement), was used as a measure of reliability and Spearman's rank correlation coefficient for correlation between MAS and SFS. Results: Neurological level ranged from C2 to L2 and American Spinal Injury Association impairment scale A to D. Time since injury was (mean ± s.d.) 3.4 ± 6.5 years. Age was 48.3 ± 20.2 years. Cause of injury was traumatic in 55% and non-traumatic for 45% of the participants. Antispastic medication was used by 61%. MAS showed intra-rater κ simple = − 0.11 to 0.46 and κ weighted = − 0.11 to 0.83. Inter-rater κ simple = − 0.06 to 0.32 and κ weighted = 0.08 to 0.74. SFS showed intra-rater κ weighted = 0.94 and inter-rater κ weighted = 0.93. Correlation between MAS and SFS showed non-significant correlation coefficients from − 0.11 to 0.90. Conclusion: Reliability of MAS is highly affected by the weighting scheme. With a weighted-κ it was overall reliable and simple-κ overall unreliability. Repeated tests should always be performed by the same rater and in a very standardized manner. SFS was found reliable. MAS and SFS are poorly correlated, and ratings were inversely distributed and suggest that it assesses different aspects of spasticity.

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Section: Discussionmentioning

confidence: 98%

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

2016

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“…In a later study, Pandyan et al 49 found that RTPM in the impaired arm was greater than in the nonimpaired arm. Likewise, RTPM was greater in those with MAS score higher than 0 compared to those with MAS score 0.…”

Section: Reliability Of Isokinetic Dynamometer Measurementsmentioning

confidence: 88%

“…In the clinical set up used by Pandyan et al, 48,49 it is difficult to standardize the stretch velocity, which is an important parameter in comparing resistance to stretch. Further, as they state, the RTPM is measured as force and not as torque, which makes it difficult to compare measurements between and within subjects when the lever arm is not standardized.…”

Section: Reliability Of Isokinetic Dynamometer Measurementsmentioning

confidence: 99%

Spasticity-assessment: a review

2006

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Study design: Review of the literature on the validity and reliability of assessment of spasticity and spasms. Objectives: Evaluate the most frequently used methods for assessment of spasticity and spasms, with particular focus on individuals with spinal cord lesions. Setting: Clinic for Spinal Cord Injuries, Rigshospitalet, University Hospital of Copenhagen, and Department of Medical Physiology, University of Copenhagen, Denmark. Methods: The assessment methods are grouped into clinical, biomechanical and electrophysiological, and the correlation between these is evaluated. Results: Clinical methods: For assessment of spasticity, the Ashworth and the modified Ashworth scales are commonly used. They provide a semiquantitative measure of the resistance to passive movement, but have limited interrater reliability. Guidelines for the testing procedures should be adhered to. Spasm frequency scales seem not to have been tested for reliability. Biomechanical methods such as isokinetic dynamometers are of value when an objective quantitative measure of the resistance to passive movement is necessary. They play a minor role in the daily clinical evaluation of spasticity. Electrophysiological methods: These techniques have provided valuable insight to the pathophysiological mechanisms involved in spasticity, but none of these techniques provide an easy and reliable assessment of spasticity for use in the daily clinic. Conclusion: A combination of electrophysiological and biomechanical techniques shows some promise for a full characterization of the spastic syndrome. There is a need of simple instruments, which provide a reliable quantitative measure with a low interrater variability.

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“…Many authors tried to determine whether the parameters of isokinetic dynamometer measurement were appropriate for the quantification of spasticity. 3,4,6,9,14 However, conflicting and inconclusive data were reported for the heterogeneity of patients examined (aetiology of spasticity, MAS score) and isokinetic protocol (speed, order of testing, EMG activity recording). ).…”

Section: Discussionmentioning

confidence: 99%

“…19 The MAS measures passive resistance to motion but is unable to distinguish between resistance caused by biomechanical and neural factors, such as changes in soft tissue length and spasticity. 14 Patients with mid-range MAS scores, because of passive stiffness alone, could be incorrectly judged to have mild-to-moderate spasticity, and in patients with contracture 20 spasticity might be overestimated and, consequently, treated inappropriately. The isokinetic dynamometry, but not the MAS, provides a measure of resistive torque that reflects both the reflex and the non-reflex muscle tone components.…”

Section: Assessment Of Hypertonus In Traumatic Sci Individuals a Gripmentioning

confidence: 99%

Biomechanical and electromyographic assessment of spastic hypertonus in motor complete traumatic spinal cord-injured individuals

et al. 2010

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Study design: Between-groups design with repeated measures. Objective: To quantify spastic hypertonia in spinal cord-injured (SCI) individuals. Setting: Rehabilitative Center, Italy. Subjects: 29 individuals with a motor complete SCI (American Spinal Injury Association impairment scale grade A or B) and 22 controls. Methods: According to the modified Ashworth scale (MAS), patients were subgrouped as SCI-1 (MAS ¼ 1, 1 þ ) and SCI-2 (MAS ¼ 2, 3). Passive flexo-extensions of the knee were applied using an isokinetic device (LIDO Active) at 301, 601, 901 and 1201 s À1 . We measured the peak torque, mean torque (MT) and work. Simultaneous electromyography (EMG) was recorded from leg muscles. Results: At the speed of 1201 s À1 all SCI-2 patients presented EMG reflex activities in the hamstring muscle. All biomechanical parameter values increased significantly according to speed, but analysis of variance revealed a significant interaction between the angular velocity and group (F(d.f. 6, 138) ¼ 8.89, Po0.0001); post hoc analysis showed significantly greater torque parameter values in the SCI-2 group compared with the SCI-1 group and the control group at 901 and 1201 s À1 . Receiver operating characteristic curves showed that using peak torque values the probability of correctly classifying a patient into SCI-1 and SCI-2 was 95%, compared with 70% for MT and 68% for work. Conclusions: The isokinetic device is useful for distinguishing individuals with a high level of spastic hypertonus. Examination of EMG activity may help ascertain whether increased muscle tone is caused by reflex hyper excitability and to determine whether muscle spasm is present. Peak torque and simultaneous EMG assessment should be considered for the evaluation of individuals with SCI in the rehabilitative context, that is, in measuring therapeutic interventions.

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A biomechanical investigation into the validity of the modified Ashworth Scale as a measure of elbow spasticity

Abstract: The modified Ashworth Scale does not provide a valid measure of spasticity at lower grades but it may provide a measure of resistance to passive movement.

Cited by 135 publications

References 10 publications

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

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

Spasticity-assessment: a review

Biomechanical and electromyographic assessment of spastic hypertonus in motor complete traumatic spinal cord-injured individuals

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