Spasticity-assessment: a review

Biering‐Sørensen, Fin; Nielsen, Jens Bo; Klinge, K

doi:10.1038/sj.sc.3101928

Cited by 265 publications

(201 citation statements)

References 78 publications

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“…Several authors have purported the merit of a test battery approach, similar to that of the Spinal Cord Assessment Tool for Spastic Reflexes, 26 for the refinement of current measures or development of new spasticity measures. 3,4,9,10 These new or refined measures will also need to undergo formal assessment of their reliability and validity before broad dissemination. The author's seek to engage the clinical and research community in resolving this ongoing measurement dilemma.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 In a recent review, the authors acknowledged 'the common clinical conundrum of the ability of clinicians to easily recognize spasticity although its quantification remains elusive'. 4 Spasticity is often categorized symptomatically as either tonic or phasic. Decq (2003) 2 suggests that tonic spasticity is the increased muscle tone resulting from the exaggerated tonic component of the stretch reflex.…”

Section: Spasticitymentioning

confidence: 99%

“…The reader is referred to two recent reviews discussing the merits of these various techniques. 4,17 The modified Ashworth scale (MAS) is a six-category ordinal scale used to assess the resistance encountered during passive muscle stretching that does not require instrumentation and is quick to perform. 18 The MAS is the current standard for clinical assessment of lower extremity spasticity, and the most commonly used tool to evaluate the efficacy of pharmacologic and rehabilitation interventions for treatment of spasticity among patients with SCI.…”

Section: Spasticity Measuresmentioning

confidence: 99%

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

Craven

Morris

2009

Spinal Cord

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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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Section: Discussionmentioning

confidence: 99%

Section: Spasticitymentioning

confidence: 99%

Section: Spasticity Measuresmentioning

confidence: 99%

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

Craven

Morris

2009

Spinal Cord

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“…3 These changes in soft tissues and joints can be very difficult to distinguish clinically from the active part of spasticity. 7 It is also important to keep in mind that the symptoms increased tone, clonus and spasms, and hyperreflexia can exist independently of each other and do not necessary share the exact same pathophysiology. 8 A number of ways to measure spasticity exist: scales for manually testing, biomechanical and electrophysiological methods, 7 as well as self-rating scales.…”

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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“…41 Loss of segmental and descending Pl-TA CR modulation after SCI Several candidate pathophysiological mechanisms could mediate the loss of physiological inhibition of the Pl-TA CR observed during controlled isometric plantarflexion in subjects with the SCI spasticity syndrome. 43 At the spinal level, dysfunction of spinal inhibitory mechanisms mediated by gamma-aminobutyric acid is related to cutaneous hyperreflexia after SCI, 44,45 whereas other structural spinal changes are associated with reflex dysfunction as a consequence of the loss of supraspinal descending control mechanisms. 21 Damage to descending supraspinal pathways, 20,46 including the corticospinal 47,48 or extrapyramidal control systems, 19,46,49 also may contribute specifically to the change in CR modulation observed during controlled plantarflexion.…”

Section: Discussionmentioning

confidence: 99%

Abnormal cutaneous flexor reflex activity during controlled isometric plantarflexion in human spinal cord injury spasticity syndrome

et al. 2016

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Study design: Although abnormal cutaneous reflex (CR) activity has been identified during gait after incomplete spinal cord injury (SCI), this activity has not been directly compared in subjects with and without the spasticity syndrome. Objectives: Characterisation of CR activity during controlled rest and 'ramp and hold' phases of controlled plantarflexion in subjects with and without the SCI spasticity syndrome. Design: Transverse descriptive study with non-parametric group analysis. Setting: SCI rehabilitation hospital. Methods: Tibialis Anterior (TA) reflexes were evoked by innocuous cutaneous plantar sole stimulation during rest and ramp and hold phases of plantarflexion torque in non-injured subjects (n = 10) and after SCI with (n = 9) and without (n = 10) hypertonia and/or involuntary spasm activity. Integrated TA reflex responses were analysed as total (50-300 ms) or short (50-200 ms) and long-latency (200-300 ms) activity. Results: Total and long-latency TA activity was inhibited in non-injured subjects and the SCI group without the spasticity syndrome during plantarflexion torque but not in the SCI spasticity group. Furthermore, loss of TA reflex inhibition during plantarflexion correlated with time after SCI (ρ = 0.79, P = 0.009). Moreover, TA reflex activity inversely correlated with maximum plantarflexion torque in the spasticity group (ρ = − 0.75, P = 0.02), despite similar non-reflex TA electromyographic activity during plantarflexion after SCI in subjects with (0.11, 0.08-0.13 mV) or without the spasticity syndrome (0.09, 0.07-0.12 mV). Conclusions: This reflex testing procedure supports previously published evidence for abnormal CR activity after SCI and may characterise the progressive disinhibition of TA reflex activity during controlled plantarflexion in subjects diagnosed with the spasticity syndrome. Spinal Cord (2016) 54, 687-694; doi:10.1038/sc.2016.9; published online 23 February 2016 INTRODUCTION Spasticity was originally defined as an increase in velocity-dependent, tonic stretch reflexes to passive movement 1 and has been used to describe a number of signs and symptoms that together contribute to the syndrome. 2 Cutaneous reflex (CR) dysfunction has also been regarded as an additional sign of the spasticity syndrome following spinal cord injury (SCI), 3-9 especially when detected in subjects with hypertonia and increased tonic stretch reflexes. [10][11][12] In addition, abnormal flexor reflex excitability is present during subacute 4,13 and chronic SCI, 14,15 impacts on residual gait function after SCI 16 and interferes with daily activities. 17 Lower limb CR activity in humans is modulated by several segmental and descending control mechanisms, 18-21 and the loss of descending modulatory mechanisms may contribute to the SCI spasticity syndrome. Tibialis Anterior (TA) muscle reflex activity evoked following cutaneous stimulation of the plantar surface (Pl-TA CR) [22][23][24] has been used as a test to assess the integrity of segmental and descending motor control mechanisms in healthy...

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Spasticity-assessment: a review

Cited by 265 publications

References 78 publications

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

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

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

Abnormal cutaneous flexor reflex activity during controlled isometric plantarflexion in human spinal cord injury spasticity syndrome

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