Reliability of Three Clinical Measures of Muscle Tone in the Shoulders and Wrists of Poststroke Patients

Abstract

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.

Relationships among Three Clinical Measures of Muscle Tone in Shoulders and Wrists of Patients with Poststroke Conditions

“…The short-term effect of vigorous grip activity upon the balance among the biomechanical components of tissue forces was demonstrated by Worley (1989). These findings and those of Worley et al (1991) suggest that manipulating the joint while measuring muscle tone itself alters tissue biomechanical properties and contributes to the variability of measurement. The results indicate that activity of a muscle group within an extremity may have an almost immediate effect upon static mechanical forces within the extremity, resulting in an alteration of the resting position.…”

“…The correlations were based on the same subgroupings (all subjects, joint first measured, joints with high tone [RM > 11, and centre) used in the original study (Worley et al 1991) because of the variability in their results and to control for the same factors. After collection on either a .…”

“…Worley et al (1991) reported reliable (Pearson's r and Spearman's Rho between .82 and .91, p < .05) measures of resting joint position, resistance to passive movement and the angle resistance appears at the shoulder (SJP, SRM & SAR), resting joint position (WJP) and resistance to passive movement (WRM) at the wrist, and a moderately reliable measure of the angle of appearance of resistance at the wrist. The absence of reliable methods to measure muscle tone clinically may have contributed to this lack of supporting clinical data.…”

Relationships among Three Clinical Measures of Muscle Tone at the Elbows of Individuals after a Stroke

“…Cette étude visait également la cueillette de données pouvant aider l'ergothérapeute à sélectionner des évaluations cliniques efficaces du tonus musculaire et à comprendre les facteurs qui contribuent aux dysfonctions occupationnelles. Acceptance of the associations among these factors [resistance to passive movement or stretch (RM), the angle during movement where the resistance appears (AR), or stretch reflex threshold, (Katz & Rymer 1989, Power, Campbell & Rymer, 1989, Power, Marder-Meyer & Rymer, 1988, Wolf et al, 1996; and the joint resting position (JP), (Worley et al, 1991)] is widespread among clinicians (Bohannon & Smith, 1987, Preston, 1998, Trombly, 1995, Wilson, 1992. Un premier ergothérapeute a d'abord mesuré le tonus musculaire au repos (TMR) du coude atteint, la résistance du coude à l'extension passive (REP) et l'angle selon lequel la résistance commençait à apparaître (ARA).…”

“…Voluntary upper extremity function was suspected to have been a confounding factor that reduced the reliability of the Resistance to Passive Movement Scale (RPMS) at the shoulder and wrist (Worley et al 1991).…”