Fluctuations of spasticity in the lower limbs in patients with multiple sclerosis

Abstract

A study of 25 patients with multiple sclerosis was performed to observe fluctuations of spasticity in the lower limbs during the day. Six muscle groups were tested on the left and right side, including the extensors, the adductors and the internal rotators of the hip, the flexors and extensors of the knee and the plantar flexors of the ankle. Spasticity was evaluated in supine position with the Ashworth scale four times during one day between 7.30 a.m. and 8.00 p.m. The data were analysed with the Friedman test. No statistically significant fluctuations in muscle tone were disclosed (α = 0.05) except for the knee extensors on the right side. An additional analysis with statistics of concordance based on the comparison of consecutive scores confirmed the finding that no major changes of spasticity were registered with the Ashworth scale for the 25 patients during the period of testing. The general opinion of clinicians, that spasticity is a variable phenomenon, was not supported statistically by the results of the present study, possibly because of the standardization of the test situation. The fact that standardization of the test situation might be enough to obtain steady scores on the Ashworth scale could be interesting in studies of the effects of treatments on spasticity.

Get full access to this article

View all access options for this article.

References

Waksman BH Multipele sclerose: recente ontwikkelingen. Medisearch 1988; 15: 15-24.

De Souza LH Multiple sclerosis: approaches to management. London: Chapman and Hall, 1990.

Scheinberg L. , Smith CR Rehabilitation of patients with multiple sclerosis . Neurol Clin 1987; 5: 585-600.

Bauer HJ Problems of symptomatic therapy in multiple sclerosis. Neurology 1978; 28: 8-20.

Ketelaer P. De spasticiteit: klinisch aspect. Tijdschrift voor medische informatie en statistiek 1979; 10: 14.

Lance JW Symposium synopsis. In: Feldman RG , Young RR , Koella WP eds. Spasticity: disordered motor control. Chicago : Year Book Publishers, 1980.

De Souza LH , Musa IM The measurement and assessment of spasticity. Clin Rehabil 1987; 1: 89-96.

Katz RT , Rymer WZ Spastic hypertonia: mechanisms and measurement. Arch Phys Med Rehabil 1989; 70: 144-55.

Ashworth B. Preliminary trial of carisoprodol in multiple sclerosis. Practitioner 1964; 192: 540-42.

10.

van den Berg JP , van Asbeck Fwa. A 24-hour monitoring of spasticity: a preliminary report. J Rehabil Sci 1991; 4: 46-48.

11.

Atkinson HW Principles of assessment. In: Downie PA ed. Cash's textbook of neurology for physiotherapists, fourth edition . London: Faber and Faber, 1986.

12.

Marsden D ed. Treating spasticity: pharmacological advances. An international symposium held during the Congress of the International Medical Society of motor disturbances (ISMD). Toronto: Hans Huber, 1988.

13.

van Cranenburgh B. Inleiding in de toegepaste neurowetenschappen. Deel 2. Herstel na hersenletsel. Lochem: De Tijdstroom, 1989.

14.

Kurtzke JF Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 1983; 33: 1444-52.

15.

Bohannon RW , Smith MB Interrater reliability of a modified Ashworth scale for measuring muscle spasticity. Phys Ther 1987; 67: 206-207.

16.

Lee K-C. , Carson L. , Kinnen E. , Patterson V. The Ashworth scale: a reliable and reproducible method of measuring spasticity . J Neuro Rehabil 1989; 3: 205-209.

17.

Sloan RL , Sinclair E. , Thompson J. , Taylor S. , Pentland B. Inter-rater reliability of the modified Ashworth scale for spasticity in hemiplegia . Int J Rehabil Res 1992; 15: 158-61.

18.

Nuyens G. , de Weerdt W. , Ketelaer P. et al. Interrater reliability of the Ashworth scale in multiple sclerosis . Clin Rehabil 1994; 8: 286-92.

19.

Siegel S. , Castellan NJ Nonparametric statistics for the behavioral sciences, second edition . New York: McGraw-Hill, 1988.

20.

Kramer MS , Feinstein AR Clinical biostatistics. LIV. The biostatistics of concordance. Clin Pharmacol Ther 1981; 29: 111-23.