Reliability of the Modified Ashworth Scale in the assessment of plantarflexor muscle spasticity in patients with traumatic brain injury

Allison, Stephen; Abraham, Lawrence D.; Petersen, Curtis L.

doi:10.1097/00004356-199603000-00007

Cited by 82 publications

(48 citation statements)

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“…The use of inexperienced assessors has been questioned, 29 but future studies are needed to evaluate the effect of training on the reliability of the scales. 23,27 Allison et al 24 found for plantar flexor muscles that the interrater reliability was significantly lower than reported for elbow flexor spasticity by Bohannon and Smith. 20 They argued that there was no support for a continued use of the MAS scale to evaluate plantar flexor spasticity in persons with traumatic brain injury.…”

Section: The Ashworth and Modified Ashworth Scalesmentioning

confidence: 84%

“…In addition, the possibility that the degree of spasticity may change for a given test person between tests should be considered. 24 For research purposes, it is essential that the rater has received adequate training before commencing the testing procedure, and that well-described standardized procedures are available and adhered to. Because of the high inter-rater variability, it is recommended that only one rater performs all the tests in an investigation.…”

Section: The Ashworth and Modified Ashworth Scalesmentioning

confidence: 99%

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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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Section: The Ashworth and Modified Ashworth Scalesmentioning

confidence: 84%

Section: The Ashworth and Modified Ashworth Scalesmentioning

confidence: 99%

Spasticity-assessment: a review

2006

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“…This finding suggests that clinical measures such as the MAS, though widely accepted by the clinical community, are "context-specific," i.e., they may not necessarily reflect the alterations in the passive properties of (spastic or nonspastic) hypertonic ankles. Moreover, it has been reported that the psychometric properties of the MAS are poor (Rydahl and Brower 2004), and, given their ordinal nature, MAS scores tend to cluster in the lower ranges, limiting its ability to discriminate between individuals or groups (Allison et al 1996;Blackburn et al 2002). Studies have also found that its interrater reliability is good for the upper extremity, e.g., elbow flexors (Bohannon and Smith 1987), but poor for the lower extremity, e.g., ankle plantar flexors (Blackburn et al 2002;Biering-Sørensen et al 2006).…”

Section: Clinical Measures Do Not Necessarily Reflect Changes In Passmentioning

confidence: 99%

Measurement of passive ankle stiffness in subjects with chronic hemiparesis using a novel ankle robot

Roy¹,

Krebs²,

Bever³

et al. 2011

Journal of Neurophysiology

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“…Despite our attempts to reduce subject variability and standardize the testing method, 23,24 our results are consistent with those of Allison et al 23 and Blackburn et al 24 Allison et al 23 used the MAS to assess plantarflexor spasticity on 30 individuals with traumatic brain injury and found average intra-rater reliability (r ¼ 0.55 and 0.74; k ¼ 0.29 and 0.69; tÀb ¼ 0.48 and 0.67) and average inter-rater reliability (r ¼ 0.73; k ¼ 0.4; tÀb ¼ 0.65). 23 The poor reliability of the MAS when applied to the ankle was speculated as due to a short lever arm of the ankle making it more difficult to determine the resistance during movement.…”

Section: Muscle Groupmentioning

confidence: 99%

“…23 The poor reliability of the MAS when applied to the ankle was speculated as due to a short lever arm of the ankle making it more difficult to determine the resistance during movement. Blackburn et al 24 used the MAS to assess lower-limb muscle spasticity of 20 patients 2 weeks after stroke, and repeated the test on 12 of the patients at 12 weeks after stroke.…”

Section: Muscle Groupmentioning

confidence: 99%

Modified Ashworth scale reliability for measurement of lower extremity spasticity among patients with SCI

2009

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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.

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Reliability of the Modified Ashworth Scale in the assessment of plantarflexor muscle spasticity in patients with traumatic brain injury

Cited by 82 publications

References 0 publications

Spasticity-assessment: a review

Spasticity-assessment: a review

Measurement of passive ankle stiffness in subjects with chronic hemiparesis using a novel ankle robot

Modified Ashworth scale reliability for measurement of lower extremity spasticity among patients with SCI

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