Measuring spasticity

[Ozy]

Hello,
What is the best way for measuring spasticity? I know about Ashworth Scale, but is there any more objective testing (without expensive equipment)?
Thank you

Similar Threads:

• measuring C7 pain pressure thresholds
• Methods of measuring RoM in knee
• Measuring knee RoM's
• Measuring strength
• Assessment tools for measuring posture

[Hussam]

Hello,
What is the best way for measuring spasticity? I know about Ashworth Scale, but is there any more objective testing (without expensive equipment)?
Thank you

ashworht scale !!!

[Ozy]

Hussam, thank you!

[st.martin]

hi ozy and hussam,

I would not recommend to use the AS or MAS. Both the ashworth (AS) and the modified ashworth scale (MAS) suffer from important limitations in grading spasticity.
Passive movement is measured at only one speed. therefore you can not differentiate between reflex mediated resistance and mechanical resistance (e.g. contracture, thixotrophy or changed visco elastic properties in the muscle)
a good review over the MAS and AS was written by pandayan and coworkers in 1999 and published in clinical rehabilitation.
A better instrument to measure spasticity may be the Tardieu scale (here passive movement is scored at three different velocities (slow, limb falling (gravity speed) and faster than gravity)
A trial comparing MAS and TS was published 2006 by Ada, again in clinical rehabilitation.

martin

[physio_swapna]

hi st.martin, What about Modified Modified Ashworth Scale ? Is it better than Tardieu Scale?
Thank you

[vaibhav yadav]

swapna u know abt AS n here's Tardieu Scale for compare it urself do tell us wat u think!!!!


Tardieu Scale


This test is performed with patient in the supine position, with head in midline.
Measurements take place at 3 velocities (V1, V2, and V3).􀀁 Responses are recorded at each
velocity as X/Y, with X indicating the 0 to 5 rating, and Y indicating the degree of angle at
which the muscle reaction occurs.􀀁By moving the limb at different velocities, the response to
stretch can be more easily gauged since the stretch reflex responds differently to velocity.


Velocities:
V1: As slow as possible, slower than the natural drop of the limb segment under
gravity
V2: Speed of limb segment falling under gravity
V3: As fast as possible, faster than the rate of the natural drop of the limb segment
under gravity


Scoring:
0 No resistance throughout the course of the passive movement
1 Slight resistance throughout the course of passive movement, no clear
catch at a precise angle
2 Clear catch at a precise angle, interrupting the passive movement, followed
by release
3 Fatigable clonus with less than 10 seconds when maintaining the pressure
and appearing at the precise angle
4 Unfatigable clonus with more than 10 seconds when maintaining the
pressure and appearing at a precise angle
5 Joint is immovable


Example:
When testing spasticity of the hamstring at the speed V1, place the patient in the supine
position.􀀁Flex the hip to 90 degrees, with the opposite hip extended (as for popliteal angle
test).􀀁Beginning with the knee flexed, extend the knee as slowly as possible.􀀁If a clear catch
interrupts the passive movement at -70 degrees of extension, followed by a release
facilitating further extension to -50 degrees of extension, then the Tardieu V1 score would
be 2/-70.􀀁 The rating would be repeated for V2 and V3 velocities. Evaluating movement of a
part at different velocities may help distinguish passive stiffness from spasticity

[gcoe]

there are a couple of posts on measuring spasticity and I just advocated the Tardieu scale on the other one before I read your comment, vaibhav yadav:

http://www.physiobob.com/forum/neuro...rth-scale.html

I agree that it is superior to the Ashworth scale. There has also been a lot of validation of the Tardieu in the last few years, even though it is actually a very old measure.

[rini kuriakose]

hello..

i jus finished ma u.g....could u plz tell me the best treatment and positioning..for right hemiparesis..(the rt arm functions better but not the leg)...

[oc1dean]

As a survivor it was interesting to find out that researchers don't believe that treating spasticity after stroke leads to a better recovery.
letter to the editor of Stroke magazine from William M. Landau.
Spasticity After Stroke: Why Bother? * Response -- Landau et al. 35 (8): 1787 -- Stroke
Spasticity After Stroke: Why Bother?
(Stroke. 2004;35:1787.)
© 2004 American Heart Association, Inc.

Spasticity - Pathophysiology
Subject: Incidence and Consequences of Spasticity After Stroke
The authors conclude, “spasticity seems to contribute to motor impairments and activity limitations and may be a severe problem for some patients after stroke,” but, given the relatively low numbers of patients with spasticity, they note, “Our findings support the opinion…that the focus on spasticity in stroke rehabilitation is out of step with its clinical importance.

[gcoe]

Hi oc1dean
Thanks for the very useful Movement Disorder University URL. This site gives a great run-down on spasticity and related issues, the various causal theories and pathophysiology, assessment and management.

My understanding is that spasticity after stroke remains a very real problem for a sizeable number of people with stroke, particularly in the chronic phase of recovery, and remains difficult to find effective management that really helps people.

The conclusion that spasticity may not be such a central problem in people with stroke grew for three reasons:

1. When one starts to investigate spasticity it is a real Pandora’s box – and what people with upper motor neurone syndrome present with is highly complex, varies from patient to patient and some of the aspects are not at all well understood. Spasticity was often used as a blanket term to cover a number of observed phenomena: velocity dependent increase response to stretch, hyperactive reflexes, abnormal reflexes, motor control problems such as delayed contraction on voluntary effort, inability to switch off a muscle on voluntary command, excessive co-contraction across a joint, abnormal synergistic action across a number of joints (most commonly flexor synergy in the arm and extensor synergy in the leg), associated reactions, contracture and so on. Part of the problem was seen as bad science – using this global term to define all these divergent phenomena. So what researchers have done is to more closely define spasticity and many now limit the discussion to abnormal velocity-dependent resistance to stretch due to abnormal neural activity. When compared with the most common impairments seen (namely weakness) velocity-dependent resistance to stretch wasn’t found to contribute that much to the disruption to purposeful movement. In contrast weakness, which had been under-estimated was found to be a very major factor. Contracture – often misdiagnosed as spasticity – where there is a shortening of the musculotendinous unit and often changes in the joint as well, is another major factor on disability.

2. Some of the earlier methods of physiotherapy devised for treating stroke had a whole emphasis on reducing spasticity, based on the premise that spasticity and abnormal reflexes were the primary interference with the recovery of normal movement, and that by reducing spasticity normal movement could then be facilitated. Time has shown that these methods were unrealistic (therapists couldn’t really reduce spasticity), the rationale for these methods simplistic and these methods weren’t particularly efficient at promoting normal movement. Since then there has been much more interest in how to promote skilled movement.

3. The emphasis on has been on acute and subacute rehab and I think in these stages spasticity and related phenomena may be less obvious a problem then what appears in later months and years post stroke.

In short there are potentially lots of disabling motor components to stroke. The emphasis in the last few years has been more on developing effective strategies for improving skilled movement. However I don’t think that clinicians and many researchers have completely abandoned investigating the management of the problems related to spasticity. For example the use of Botox combined with aggressive physical therapy for spasticity, often where contracture coexists, has some evidence of effectiveness. And there are lots of conditions other than stroke, where spasticity remains a major hurdle and needs to be better understood. So I don’t think that spasticity has disappeared off the research map and there will be continued interest in it and related problems – particularly as more time and money is spent on living longer with these problems.

What is your experience of the physical therapy you have received? Do you feel spasticity has been ignored?

[oc1dean]

Thanks for the detailed explanation of spasticity, I couldn't find anyone who knew about it. My first PMR doctor knew nothing about spasticity, he wanted to snip the tendons for curled toes rather than knowing about toe crests and metatarsal bumps. none of the therapists knew about spasticity either, but at least I found out that exercise does not increase spasticity. I had to find out about Brunnstroms six stages of recovery myself. I consider myself mildly spastic, but it is an oxymoron that I am not paralyzed enough to easily recover using neuroplasticity.

[gcoe]

You must have found that a discouraging and disappointing experience in your health system. Even though rehab professionals may have differing opinions about the relative importance of spasticity, what is is and how it can be treated, I would have expected a PMR and PT to know something about spasticity and to be acquainted with the area.

It doesn't surprise me that your professionals may not have known much about Signe Brunnstrom’s stages of recovery or her therapeutic methods. At the time (1970's onward) there was a fierce debate about the role of spasticity and how to treat it. Her nemesis, Berta Bobath had a contrary view about spasticity and abnormal reflexes. Basically Bobath believed we should suppress abnormal activity at all costs as it would interfere with recovery while Brunnstrom considered such activity an important step in the recovery of function and that we should use such activity to strengthen the patient. In my part of the world the Bobath Method (in your country often referred to as NDT) dominated the teaching and practice. Because of this "war of views" we weren't exposed to Brunnstrom's ideas which on reflection was a a pity. Of the two Brunnstrom was the greater applied scientist – a real contributor to the observation of normal and abnormal movement at the time. The fact that she emphasised both strengthening and patient lead practice that aimed at skilled movement was ahead of her time. Based on our current knowledge I don’t know if I agree with the staged recovery model however – but that is another story.

Two questions: May I ask what you consider your main problems in terms of what you can’t do now? Would you like me to send you some recent articles on the treatment of spasticity? You may already have them but I have a few new studies stacked away here. If you would like them, however you’ll have to send me an email address – for copyright reasons I can’t post them on public display and the private mail doesn’t have an attachment facility. You can PM me if you want.

[sungjem]

what wil b the treatment approaches in cervical meningitis

[gcoe]

Hi Sungjem

This is a thread about measuring spasticity. It is not about cervical meningitis. I suggest you do the following:


1. Start a new thread on cervical meningitis
2. Provide background information to your case - what symptoms and impairments does the patient have; How is it affecting their day-to-day function, How was it medically managed. Just giving the discussion members a diagnosis gives them nothing to work from. Physiotherapy has to be based on addressing such things as the impairments and the activity limitations your patient is experiencing. You can't just prescribe physiotherapy for a given condition as people present differently.

These are good rules when asking for information for any condition.