Spasticity, an impairment that is poorly defined and poorly measured

Malhotra, Shweta; Pandyan, Anand; Day, Charles; Jones, Peter W.; Hermens, Hermie

doi:10.1177/0269215508101747

Cited by 190 publications

(165 citation statements)

References 16 publications

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“…35,36 A positive correlation has been reported between the Ashworth scale and indices of clonus and spasm, 37 therefore the negative correlation between MAS and the injury duration observed in this study suggest that the frequency of involuntary muscle contraction because of spasm gradually decreases over time after SCI. In evaluating the extent of spasticity over time, we found no statistically significant correlation between the stretch reflex gain and offset in the lower muscles (MG, Sol) and injury duration.…”

Section: Discussionsupporting

confidence: 48%

Mechanical and neural changes in plantar-flexor muscles after spinal cord injury in humans

et al. 2015

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Study design: Cross-sectional study. Objectives: To determine the effect of injury duration on plantar-flexor elastic properties in individuals with chronic spinal cord injury (SCI) and spasticity. Setting: National Rehabilitation Center for Persons with Disabilities, Japan. Methods: A total of 16 chronic SCI patients (age, 33 ± 9.3 years; injury localization, C6-T12; injury duration, 11-371 months) participated. Spasticity of the ankle plantar-flexors was assessed using the Modified Ashworth Scale (MAS). The calf circumference and muscle thickness of the medial gastrocnemius (MG), lateral gastrocnemius and soleus were assessed using tape measure and ultrasonography. In addition, the ankle was rotated from 10°plantar-flexion to 20°dorsiflexion at 5 deg s −1 with a dynamometer, and the ankle angle and torque were recorded. After normalizing the data (the initial points of angle and torque were set to zero), we calculated the peak torque and energy. Furthermore, angle-torque data (before and after normalization) were fitted with a second-and fourth-order polynomial, and exponential (Sten-Knudsen) models, and stiffness indices (SI SOP, SI FOP, SI SK ) and Angle SLACK (the angle at which plantar-flexor passive torque equals zero) were calculated. The stretch reflex gain and offset were determined from 0-10°d orsiflexion at 50, 90, 120 and 150 deg s −1 . After logarithmic transformation, Pearson's correlation coefficients were calculated. Results: MAS, calf circumference, MG thickness, peak torque and SI FOP significantly decreased with injury duration (r loglog = − 0.63, − 0.69, − 0.63, − 0.53 and − 0.55, respectively, Po0.05). The peak torque and SI FOP maintained significant relationships even after excluding impacts from muscle morphology. Conclusion: Plantar-flexor elasticity in chronic SCI patients decreased with increased injury duration.

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Section: Discussionsupporting

confidence: 48%

Mechanical and neural changes in plantar-flexor muscles after spinal cord injury in humans

et al. 2015

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“…Indeed, this situation is not uncommon in health-care research. Lack of standardised definitions for key terms and outcomes is noted in studies of whiplash-associated disorders [57], drowning [75], falls [41], spasticity [65], peptic ulcers [103] and schizophrenia [58]. This finding is likely due to the lack of a standardised measure for recovery as well as the absence of a clear and agreed-upon definition of what recovery from LBP means.…”

Section: Discussionmentioning

confidence: 99%

How is recovery from low back pain measured? A systematic review of the literature

et al. 2010

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“…3 An often used definition of spasticity is the one by Lance: 4 'a motor disorder characterized by a velocity-dependent increase in the tonic stretch reflex with exaggerated tendon jerks, resulting from hyper excitability of the stretch reflex, as one component of the upper motor-neuron syndrome'. This definition has the benefit of being precise but has been challenged 5 and does not reflect the multidimensional nature of spasticity. For the purpose of this study, we used a relatively broader definition developed by the SPASM consortium: 6 'Disordered sensory-motor control resulting from an upper motor-neuron lesion presenting intermittent or sustained involuntary activity of muscles'.…”

Section: Introductionmentioning

confidence: 99%

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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Spasticity, an impairment that is poorly defined and poorly measured

Cited by 190 publications

References 16 publications

Mechanical and neural changes in plantar-flexor muscles after spinal cord injury in humans

Mechanical and neural changes in plantar-flexor muscles after spinal cord injury in humans

How is recovery from low back pain measured? A systematic review of the literature

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

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