Intraobserver reliability of the modified Tardieu scale in the upper limb of children with hemiplegia

Abstract

This study investigated the reliability of the modified Tardieu scale in the assessment of biceps spasticity in the upper limbs of children with hemiplegic cerebral palsy (CP). Ten children, with hemiplegic CP participated in the study: six males (mean age 9 years, SD 4 years) and four females (mean age 12 years, SD 3 years). Blinded, duplicate measures of dynamic elbow extension were performed on the hemiplegic arm at time 0 and 7 days later, using the three angular velocities described in the Tardieu scale (V1, slow; V2, speed of gravity; V3, as fast as possible). The resulting elbow joint angles were defined as R1, the angle of catch following a fast velocity stretch at either V2 or V3; and R2, the passive range of movement achieved following a slow velocity stretch at V1. Both elbow joint angle and movement angular velocity were measured by three-dimensional kinematics. Median error in measured elbow joint angle within one session ranged from 3 to 5 degrees. Between sessions median absolute differences in measured elbow joint angle ranged from 4 to 13 degrees, with measurement errors of up to 25 to 30 degrees in some participants at the fastest velocity (V3). The therapist was able to apply three significantly different angular velocities as required for the Tardieu scale (p<0.001). However, the ranges of the three angular velocities overlapped, with fast velocities for some participants being equivalent to slow velocities for other participants. Three out of 10 participants had an intersessional difference in their R2-R1 score of more than 20 degrees. From this study, we concluded that the R2-R1 value determined from the modified Tardieu scale may be of limited value in assessing biceps spasticity the upper limbs in children with hemiplegic CP.

Reliability of upper and lower limb three-dimensional kinematics in children with hemiplegia

“…1) [21]. We have previously published details of a comparison of this upper limb model with goniometric measures with a strong correlation (r = 0.93) found between the mean elbow angle measured with the goniometer and the same angle measured by the 3D upper limb model [21].…”

“…1) [21]. We have previously published details of a comparison of this upper limb model with goniometric measures with a strong correlation (r = 0.93) found between the mean elbow angle measured with the goniometer and the same angle measured by the 3D upper limb model [21]. A similar comparison of frontal and sagittal plane measures at the shoulder has also shown a good correlation (r = 0.74) between the goniometric measures and the 3D measures (unpublished laboratory data).…”

Excellent test–retest and inter-rater reliability for Tardieu Scale measurements with inertial sensors in elbow flexors of stroke patients

“…Mackey et al found poor testretest reliability for Tardieu Scale measurements of elbow flexors of children with hemiplegia [21]. Ansari et al showed that the inter-rater reliability for Tardieu Scale measurements with goniometry of elbow flexors of adult patients with hemiplegia is insufficient [22].…”

Keyhole interlaminar dorsal rhizotomy for spastic diplegia in cerebral palsy

“…The spastic hypertonia was assessed with the Ashworth and Tardieu scores [4,7,20]. Locomotor evolution was followed on curves established from the Gross Motor Function Measure (GMFM).…”

“…After electrophysiological checking (lower row: e and f): e Sectioning of three of the four dorsal rootlets with microscissors. f Postsectioning view Ashworth scale: 0 to 4 (from no increase in tone to the rigid limb during flexion/extension) [4,7]; Tardieu scale: 0 to 4 (from no increase in tone to inexhaustible clonus throughout the range of motion) [20,46]; GMFCS = Gross Motor Function Classification System: I to V (from least to most severely affected) [27]; NYU = New York University: I to V (from least to most severely affected) [1][2][3]; Gillette walking scale: 1 to 10 (from cannot take any steps at all to can climb stairs without difficulty) [26] by the surgery. Special attention was paid to eventual deleterious consequences of excessive reduction of spasticity on locomotive power for transfers, standing and walking.…”