do we have to assess the muscle power & ROM in spasticit

[anjanaa]

Hello everyone
I wanted to know if we have to assess the ROM & muscle power for a spastic limb or can we use only voluntary control grades.

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[Physiobase]

ROM would be often velocity and body position dependent. As for power, why would you measure that in a spastic limb? You should always have a reason for doing a test, e.g. to direct a therapy.

If you can think of a reson to test power in a spastic movement can you please give us and idea of your approach. 8o

[Rajul vasa]

dear Anjana
in a stroke patient you know that muscle is purely a victim unlike any orthopaedic condition wherein the muscle, joint or a bone is having a primary pathology therefore ROM and voluntary power is assessed BUT in a stroke patient one does not asses the same way as in any orthopaedic condition.

you may find some answers in the following.
www.brainstrokes.com

[Morton]

Hi

Ya this is where spasticiy differs from other conditions. Though "Range of Active Motion" will be helpful to rate progress, assessing muscle power will not be of much help. However its mandatory to assess the Passive Motion in the absence of voluntary control, by varying the amplitude & velocity of movement. Always its better to compare findings with the unaffected limb.(Though they may not always be valid) studies have shown abnormal findings on even the normal(unaffected) extremity.
I hope the information provided below would answer your query to an extent.

Clinical measures of Spasticity
Range of motion
Tone intensity measures
Modifi ed Ashworth Scale
Tardieu Scale
Mechanical instruments
The pendulum test
Electrophysiological measures
The H refl ex
Vibration inhibition index
Functional measures
Upper extremity function
Gait

Modified Ashworth Scale
0 No increase in muscle tone
1 Slight increase in muscle tone, manifested by a catch and release
or by minimal resistance at the end range of motion when the part is
moved in flexion or extension/abduction or adduction, etc.
1+ Slight increase in muscle tone, manifested by a catch, followed by
minimal resistance throughout the remainder (less than half) of the
ROM
2 More marked increase in muscle tone through most of the ROM, but
the affected part is easily moved
3 Considerable increase in muscle tone, passive movement is difficult
4 Affected part is rigid in flexion or extension (abduction ,adduction, etc.)

Tardieu scale
Quality of muscle reaction is measured as:
0 No resistance throughout the course of the passive movement
1 Slight resistance throughout the course of the passive
movement
2 Clear catch at precise angle, interrupting the passive movement,
followed by release
3 Unsustained clonus (less than 10 sec when maintaining the pressure)
occurring at a precise angle, followed by release
4 Sustained clonus (more than 10 sec when maintaining the pressure)
occurring at a precise angle
Angle of muscle action is measured relative to the position of minimal stretch of
the muscle (corresponding to angle zero) for all joints except the hip where it is
relative to the resting anatomical position.[email protected]

[anjanaa]

hello
thanx a lot 4r your valuale suggestions... i would be very happy if anyone could tell me sumthing about vasa technique for stroke rehab ... thanx again

[tnmuralidharan]

hi,
I think you decide to check teh muscle strength depending upon the voluntary control that the patient has on the affected limb!! for easy reference,
assess the spasticity of the limb if it is more that 2 mas then you know that the patient may (if he has some voluntary control) use spasticity to move!! If the spasticity is less that 2 mas, the assess his voluntary control and if it ins more than grade four in the brunstroms scale then you can assess the muscle strength!!