Objective: To assess and to compare the reliability of the Modified Tardieu Scale with the Modified Ashworth Scale in patients with severe brain injury and impaired consciousness.
Setting: An early rehabilitation centre for adults with neurological disorders.
Subjects: Thirty patients with impaired consciousness due to severe cerebral damage of various aetiologies.
Measurement protocol: Four experienced physical therapists rated each patient in a randomized order once daily for two consecutive days. Shoulder, elbow, wrist, hip, knee and ankle spasticity were assessed by the use of Modified Tardieu Scale and Modified Ashworth Scale data collection procedures.
Main outcome measures: Test - retest and inter-rater reliability (k=kappa value) of the Modified Tardieu Scale and the Modified Ashworth Scale.
Results: The test-retest reliability of the Modified Ashworth Scale was moderate to good (k = 0.47-0.62) and of the Modified Tardieu Scale moderate to very good (k = 0.52-0.87). Test - retest reliability was significantly higher within the Modified Tardieu Scale in comparison with the Modified Ashworth Scale (Z<1.96; p<0.05) except for shoulder extensor and internal rotator muscles (Z<1.96; p<0.05). Although inter-rater reliability of both scales was poor to moderate (Modified Ashworth Scale: k = 0.16-0.42; Modified Tardieu Scale: k = 0.29-0.53), significantly higher k-values were revealed with the Modified Tardieu Scale for all tested muscle groups (Z<1.96; p<0.05) except for wrist extensors (Z<1.96; p<0.05).
Conclusion: In patients with severe brain injury and impaired consciousness the Modified Tardieu Scale provides higher test-retest and inter-rater reliability compared with the Modified Ashworth Scale and may therefore be a more valid spasticity scale in adults.
Get full access to this article
View all access options for this article.
References
1.
1 Pohl M, Rückriem S, Mehrholz J et al. Effectiveness of serial casting in patients with severe cerebral spasticity: a comparison study. Arch Phys Med Rehabil2002; 83: 784-790.
2.
2 Cramer SC. Editorial comment-spasticity after stroke: what's the catch?Stroke2004; 35: 139-140.
3.
3 Sommerfeld DK, Eek EU, Svensson AK, Holmqvist LW, von Arbin MH. Spasticity after stroke: its occurrence and association with motor impairments and activity limitations. Stroke2004; 35: 134-139.
4.
4 Pohl M, Rockstroh G, Rückriem S et al. Measurement of the effect of a bolus dose of intrathecal baclofen by continuous measurement of force under fibreglass casts. J Neurol2002; 249: 1254-1262.
5.
5 Katz RT, Rovai GP, Brait C, Rymer Z. Objective quantification of spastic hypertona: correlation with clinical findings. Arch Phys Med Rehabil1992; 73: 339-347.
6.
6 Pohl M, Rockstroh G, Rückriem S et al. Time course of the effect of a bolus dose of intrathecal baclofen on severe cerebral spasticity. J Neurol2003; 250: 1195-1200.
7.
7 Blackburn M, van Vliet P, Mockett SP. Reliability of measurements obtained with the modified Ashworth scale in the lower extremities of people with stroke. Phys Ther2002; 82:25-34.
8.
8 Gregson JM, Leathley M, Moore AP et al. Reliability of the Tone Assessment Scale and the modified Ashworth scale as clinical tools for assessing poststroke spasticity. Arch Phys Med Rehabil1999; 80: 1013-1016.
9.
9 Nuyens G, De Weerdt W, Ketelaer P. Interrater reliability of the Ashworth Scale in multiple sclerosis. Clin Rehabil1994; 8: 286-292.
10.
10 Haas BM, Bergstrom E, Jamous A, Bennie A. The inter rater reliability of the original and of the modified Ashworth scale for the assessment of spasticity in patients with spinal cord injury. Spinal Cord1996; 34: 560-564.
11.
11 Mehrholz J, Major Y, Meißner D et al. The influence of contractures and variation in measurement stretching velocity on the reliability of the Modified Ashworth Scale in patients with severe brain injury. Clin Rehabil2005; 19:63-72.
12.
12 Fosang AL, Galea MP, McCoy AT, Reddihough DS, Story I. Measures of muscle and joint performance in the lower limb of children with cerebral palsy. Dev Med Child Neurol2003; 45: 664-670.
13.
13 Tardieu G, Shentoub S, Delarue R. A la recherche d'une technique de mesure de la spasticité. Rev Neurol1954; 91: 143-144.
14.
14 Held J, Pierrot-Deseilligny E. Reeducation Motrice des Affections Neurologiques. Paris, 1969.
15.
15 Boyd R, Graham H. Objective measurement of clinical findings in the use of botulinum toxin type A in the management of spasticity in children with cerebral palsy. Eur J Neurol1999; 6: S23-S36.
16.
16 Boyd R, Ada L. Physiotherapy management of spasticity. In: Barnes M, Johnson G eds. Upper motor neuron syndrome and spasticity. Clinical management and neurophysiology. Cambridge, UK: Cambridge University Press, 2001: 96-121.
17.
17 Masur H. Skalen und Scores in der Neurologie. Stuttgart, New York: Thieme Verlag, 2000.
18.
18 Pandyan AD, Johnson GR, Price CI et al. A review of the properties and limitations of the Ashworth and modified Ashworth Scales as measures of spasticity. Clin Rehabil1999; 13: 373-383.
19.
19 Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther1987; 67: 206-207.
20.
20 Gracies JM, Marosszeky JE, Renton R et al. Short-term effects of dynamic lycra splints on upper limb in hemiplegic patients. Arch Phys Med Rehabil2000; 81: 1547-1555.
21.
21 Ward AB. Assessment of muscle tone. Age Ageing2000; 29: 385-386.
22.
22 Cohen J. Weighted kappa: Nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull1968; 70: 213-220.
23.
23 Armitage PTC. Encyclopedia of biostatistics. Chichester: Wiley, 1998.
24.
24 Brennan P, Silman A. Statistical methods for assessing observer variability in clinical measures. BMJ1992; 304: 1491-1494.
25.
25 Brashear A, Zafonte R, Corcoran M et al. Inter- and intra-rater reliability of the Ashworth Scale and the Disability Assessment Scale in patients with upper-limb poststroke spasticity. Arch Phys Med Rehabil2002; 83: 1349-1354.
26.
26 Brashear A, Gordon MF, Elovic E et al. Intramuscular injection of botulinum toxin for the treatment of wrist and finger spasticity after a stroke. N Engl J Med2002; 347: 395-400.
27.
27 Ashworth B. Preliminary trial of carisoprol in multiple sclerosis. Practitioner1964; 192: 540-542.
28.
28 Sloan RL, Sinclair E, Thompson J, Taylor S, Pentland B. Inter-rater reliability of the modified Ashworth Scale for spasticity in hemiplegic patients. Int J Rehabil Res1992; 15: 158-161.
29.
29 Johnson GR. Measurement of spasticity. In: Johnson G ed. Upper motor neuron syndrome and spasticity. Clinical management and neurophysiology. Cambridge: Cambridge University Press, 2001: 79-95.
30.
30 Vattanasilp W, Ada L. The relationship between clinical and laboratory measures of spasticity. Aust J Physiother1999; 45: 135-139.
31.
31 Lance J. Symposium synopsis. In: Feldman R, Young R, Koelia P eds. Spasticity. Disordered motor control. Miami, FL: Symposia Specialists, 1980: 485-500.
32.
32 Bakheit AM, Maynard VA, Curnow J, Hudson N, Kodapala S. The relation between Ashworth scale scores and the excitability of the alpha motor neurones in patients with post-stroke muscle spasticity. J Neurol Neurosurg Psychiatry2003; 74: 646-648.
33.
33 Pandyan AD, Price CI, Rodgers H, Barnes MP, Johnson GR. Biomechanical examination of a commonly used measure of spasticity. Clin Biomech (Bristol, Avon) 2001; 16: 859-865.
34.
34 Pandyan AD, Price CI, Barnes MP, Johnson GR. A biomechanical investigation into the validity of the modified Ashworth Scale as a measure of elbow spasticity. Clin Rehabil2003; 17: 290-293.
35.
35 Morris S. Ashworth and Tardieu Scales: their clinical relevance for measuring spasticity in adult and paediatric neurological populations. Phys Ther Rev2002; 53-62.
36.
36 Spizzo M, Harris P, Warden-Flow A. Intra-Rater and inter-rater reliability of the Tardieu Scale to quantify spasticity in biceps brachii in children with cerebral palsy. Aust J Physiother2002; 48: 149-149.
37.
37 Mackey AH, Walt SE, Lobb G, Stott NS. Intraobserver reliability of the modified Tardieu scale in the upper limb of children with hemiplegia. Dev Med Child Neurol2004; 46: 267-272.
38.
38 Thomas J, Nelson J. Research methods in physical activity. Champaign, IL: Human Kinetics, 1996.
39.
39 Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Measurement1960; 20:37-46.
