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Mindy F Levin - One of the best experts on this subject based on the ideXlab platform.
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tonic stretch reflex threshold as a measure of ankle plantar flexor Spasticity after stroke
2016Co-Authors: Andreanne K Blanchette, Aditi A Mullick, Karina Moindarbari, Mindy F LevinAbstract:Background Commonly used Spasticity scales assess the resistance felt by the evaluator during passive stretching. These scales, however, have questionable validity and reliability. The tonic stretch reflex threshold (TSRT), or the angle at which motoneuronal recruitment begins in the resting state, is a promising alternative for Spasticity measurement. Previous studies showed that Spasticity and voluntary motor deficits after stroke may be characterized by a limitation in the ability of the central nervous system to regulate the range of the TSRT. Objective The study objective was to assess interevaluator reliability for TSRT plantar-flexor Spasticity measurement. Design This was an interevaluator reliability study. Methods In 28 people after stroke, plantar-flexor Spasticity was evaluated twice on the same day. Plantar-flexor muscles were stretched 20 times at different velocities assigned by a portable device. Plantar-flexor electromyographic signals and ankle angles were used to determine dynamic velocity-dependent thresholds. The TSRT was computed by extrapolating a regression line through dynamic velocity-dependent thresholds to the angular axis. Results Mean TSRTs in evaluations 1 and 2 were 66.0 degrees (SD=13.1°) and 65.8 degrees (SD=14.1°), respectively, with no significant difference between them. The intraclass correlation coefficient (2,1) was .851 (95% confidence interval=.703, .928). Limitations The notion of dynamic stretch reflex threshold does not exclude the possibility that Spasticity is dependent on acceleration, as well as on velocity; future work will study both possibilities. Conclusions Tonic stretch reflex threshold interevaluator reliability for evaluating stroke-related plantar-flexor Spasticity was very good. The TSRT is a reliable measure of Spasticity. More information may be gained by combining the TSRT measurement with a measure of velocity-dependent resistance.
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Spasticity measurement based on tonic stretch reflex threshold in stroke using a portable device
2008Co-Authors: Andra Calota, Anatol G Feldman, Mindy F LevinAbstract:Abstract Objectives We investigated intra- and inter-evaluator reliability to quantify Spasticity based on the tonic stretch reflex threshold (TSRT) and the correlation between TSRT and resistance to stretch. Methods Spasticity was evaluated in 20 subjects with chronic stroke-related Spasticity using a portable device and the Modified Ashworth Scale (MAS). Evaluations were done on 2 days, by three evaluators. Biceps brachii EMG signals and elbow displacement were recorded during 20 elbow stretches applied at different velocities for each evaluation. Velocity-dependent dynamic stretch reflex thresholds (angle where EMG signal increased in the biceps for a given velocity of stretch) were recorded. These values were used to compute TSRT (excitability of motoneurons at 0°/s). Spasticity was also measured with MAS. Results Reliability was moderately good for subjects with moderate to high Spasticity (intra-evaluator: 0.46–0.68, and inter-evaluator: 0.53–0.68). The TSRT measure of Spasticity did not correlate with resistance to stretch (MAS). Conclusions TSRT may be a more representative measure for subjects with moderate to high Spasticity. Further improvements are suggested for the portable device in order to quantify all the levels of Spasticity. Significance TSRT may be an alternative clinical measure to current clinical scales.
Anand D Pandyan - One of the best experts on this subject based on the ideXlab platform.
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theoretical and methodological considerations in the measurement of Spasticity
2005Co-Authors: Jane Burridge, G R Johnson, D E Wood, Hermanus J Hermens, Gerlienke Voerman, F Van Wijck, Thomas Platz, M Gregoric, R A Hitchcock, Anand D PandyanAbstract:Purpose: To discuss the measurement of Spasticity in the clinical and research environments, make recommendations based on the SPASM reviews of biomechanical, neurophysiological and clinical methods of measuring Spasticity and indicate future developments of measurement tools. Method: Using the results of the systematic reviews of the biomechanical, neurophysiological and clinical approaches, methods were evaluated across three dimensions: (1) validity, reliability and sensitivity to change; (2) practical quality such as ease of use and (3) qualities specific to the measurement of Spasticity, for example ability to be applied to different muscle groups. Methods were considered in terms of applicability to research and clinical applications. Results: A hierarchy of measurement approaches was identified from highly controlled and more objective (but unrelated to function) to ecologically valid, but less objective and subject to contamination from other variables. The lack of a precise definition of Spasticity may account for the problem of developing a valid, reliable and sensitive method of measurement. The reviews have identified that some tests measure Spasticity per se, some phenomena associated with Spasticity or consequential to it and others the effect of Spasticity on activity and participation and independence. Conclusions: Methods appropriate for use in research, particularly into the mechanism of Spasticity did not satisfy the needs of the clinician and the need for an objective but clinically applicable tool was identified. A clinical assessment may need to generate more than one ‘value’ and should include evaluation of other components of the upper motor neurone syndrome. There is therefore a need for standardized protocols for ‘best practice’ in application of Spasticity measurement tools and scales.
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are we underestimating the clinical efficacy of botulinum toxin type a quantifying changes in Spasticity strength and upper limb function after injections of botox to the elbow flexors in a unilateral stroke population
2002Co-Authors: Anand D Pandyan, Philippe Vuadens, Frederike Van Wijck, Sandra C Stark, G R Johnson, Michael P BarnesAbstract:Objective: To quantify the clinical efficacy of botulinum toxin type A in treating elbow flexor Spasticity in a unilateral stroke population. Location: A Spasticity clinic at a regional neurological rehabilitation centre.Study design: A convenience sample longitudinal study. Fourteen subjects with elbow flexor Spasticity secondary to a stroke were recruited. Two repeated measures, one before and another four weeks after treatment, were taken to quantify clinical efficacy.Outcome measures: Elbow flexor Spasticity was simultaneously rated with the modified Ashworth scale (MAS) and quantified by measuring the surface EMG from the flexors using a custom-built device. Strength at the elbow (isometric), grip strength and upper limb function (Action Research Arm test) were also assessed.Treatment: Injections of botulinum toxin type A (Botox®) to the m.biceps brachii (mean dose 70 U), m.brachioradialis (mean dose 56.5 U) and m.flexor digitorum longus (mean dose 83.3 U).Results: Following treatment, Spasticity (as...
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a review of the properties and limitations of the ashworth and modified ashworth scales as measures of Spasticity
1999Co-Authors: Anand D Pandyan, G R Johnson, Michael P Barnes, Christopher Price, Richard Curless, Helen RodgersAbstract:Background: The Ashworth Scale and the modified Ashworth Scale are the primary clinical measures of Spasticity. A prerequisite for using any scale is a knowledge of its characteristics and limitations, as these will play a part in analysing and interpreting the data. Despite the current emphasis on treating Spasticity, clinicians rarely measure it.Objectives: To determine the validity and the reliability of the Ashworth and modified Ashworth Scales.Study design: A theoretical analysis following a structured literature review (key words: Ashworth; Spasticity; Measurement) of 40 papers selected from the BIDS-EMBASE, First Search and Medline databases.Conclusions: The application of both scales would suggest that confusion exists on their characteristics and limitations as measures of Spasticity. Resistance to passive movement is a complex measure that will be influenced by many factors, only one of which could be Spasticity. The Ashworth Scale (AS) can be used as an ordinal level measure of resistance to pa...
Michael P Barnes - One of the best experts on this subject based on the ideXlab platform.
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upper motor neurone syndrome and Spasticity clinical management and neurophysiology
2008Co-Authors: Michael P Barnes, Garth R JohnsonAbstract:Preface 1. An overview of the clinical management of Spasticity Michael P. Barnes 2. Neurophysiology of Spasticity Geoff Sheean 3. The measurement of Spasticity Garth R. Johnson and Anand D. Pandyan 4. Physiotherapy management of Spasticity Roslyn N. Boyd and Louise Ada 5. Seating and positioning Craig A. Kirkwood and Geoff I. Bardsley 6. Orthoses, splints and casts Paul T. Charlton and Duncan W. N. Ferguson 7. Pharmacological management of Spasticity Anthony B. Ward and Sajida Javaid 8. Chemical neurolysis in the management of muscle Spasticity A. Magid and O. Bakheit 9. Spasticity and botulinum toxin Michael P. Barnes and Elizabeth C. Davis 10. Intrathecal baclofen for the control of spinal and supraspinal Spasticity David N. Rushton 11. Surgical management of Spasticity Patrick Mertens and Marc Sindou 12. Management of Spasticity in children Rachael Hutchinson and H. Kerr Graham Index.
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are we underestimating the clinical efficacy of botulinum toxin type a quantifying changes in Spasticity strength and upper limb function after injections of botox to the elbow flexors in a unilateral stroke population
2002Co-Authors: Anand D Pandyan, Philippe Vuadens, Frederike Van Wijck, Sandra C Stark, G R Johnson, Michael P BarnesAbstract:Objective: To quantify the clinical efficacy of botulinum toxin type A in treating elbow flexor Spasticity in a unilateral stroke population. Location: A Spasticity clinic at a regional neurological rehabilitation centre.Study design: A convenience sample longitudinal study. Fourteen subjects with elbow flexor Spasticity secondary to a stroke were recruited. Two repeated measures, one before and another four weeks after treatment, were taken to quantify clinical efficacy.Outcome measures: Elbow flexor Spasticity was simultaneously rated with the modified Ashworth scale (MAS) and quantified by measuring the surface EMG from the flexors using a custom-built device. Strength at the elbow (isometric), grip strength and upper limb function (Action Research Arm test) were also assessed.Treatment: Injections of botulinum toxin type A (Botox®) to the m.biceps brachii (mean dose 70 U), m.brachioradialis (mean dose 56.5 U) and m.flexor digitorum longus (mean dose 83.3 U).Results: Following treatment, Spasticity (as...
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a review of the properties and limitations of the ashworth and modified ashworth scales as measures of Spasticity
1999Co-Authors: Anand D Pandyan, G R Johnson, Michael P Barnes, Christopher Price, Richard Curless, Helen RodgersAbstract:Background: The Ashworth Scale and the modified Ashworth Scale are the primary clinical measures of Spasticity. A prerequisite for using any scale is a knowledge of its characteristics and limitations, as these will play a part in analysing and interpreting the data. Despite the current emphasis on treating Spasticity, clinicians rarely measure it.Objectives: To determine the validity and the reliability of the Ashworth and modified Ashworth Scales.Study design: A theoretical analysis following a structured literature review (key words: Ashworth; Spasticity; Measurement) of 40 papers selected from the BIDS-EMBASE, First Search and Medline databases.Conclusions: The application of both scales would suggest that confusion exists on their characteristics and limitations as measures of Spasticity. Resistance to passive movement is a complex measure that will be influenced by many factors, only one of which could be Spasticity. The Ashworth Scale (AS) can be used as an ordinal level measure of resistance to pa...
G R Johnson - One of the best experts on this subject based on the ideXlab platform.
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a systematic review of the tardieu scale for the measurement of Spasticity
2006Co-Authors: A Haugh, Anand Pandyan, G R JohnsonAbstract:Background. The Tardieu Scale has been suggested a more appropriate clinical measure of Spasticity than the Ashworth or modified Ashworth Scales. It appears to adhere more closely to Lance's definition of Spasticity as it involves assessment of resistance to passive movement at both slow and fast speeds.Objective. To review the available literature in which the Tardieu Scale has been used or discussed as a measure of Spasticity, with a view to determining its validity and reliability.Study design. A systematic review of all literature found related to the Tardieu Scale (keywords: Tardieu scale, Spasticity) from Pubmed and Ovid databases, including medline, CINAHL, EMBASE, Journals at Ovid full text, EBM reviews and Cochrane database of systematic reviews. Hand searching was also used to track the source literature.Conclusions. In theory, we can acknowledge that the Tardieu Scale does, in fact, adhere more closely to Lance's definition of Spasticity. However, there is a dearth of literature investigating v...
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theoretical and methodological considerations in the measurement of Spasticity
2005Co-Authors: Jane Burridge, G R Johnson, D E Wood, Hermanus J Hermens, Gerlienke Voerman, F Van Wijck, Thomas Platz, M Gregoric, R A Hitchcock, Anand D PandyanAbstract:Purpose: To discuss the measurement of Spasticity in the clinical and research environments, make recommendations based on the SPASM reviews of biomechanical, neurophysiological and clinical methods of measuring Spasticity and indicate future developments of measurement tools. Method: Using the results of the systematic reviews of the biomechanical, neurophysiological and clinical approaches, methods were evaluated across three dimensions: (1) validity, reliability and sensitivity to change; (2) practical quality such as ease of use and (3) qualities specific to the measurement of Spasticity, for example ability to be applied to different muscle groups. Methods were considered in terms of applicability to research and clinical applications. Results: A hierarchy of measurement approaches was identified from highly controlled and more objective (but unrelated to function) to ecologically valid, but less objective and subject to contamination from other variables. The lack of a precise definition of Spasticity may account for the problem of developing a valid, reliable and sensitive method of measurement. The reviews have identified that some tests measure Spasticity per se, some phenomena associated with Spasticity or consequential to it and others the effect of Spasticity on activity and participation and independence. Conclusions: Methods appropriate for use in research, particularly into the mechanism of Spasticity did not satisfy the needs of the clinician and the need for an objective but clinically applicable tool was identified. A clinical assessment may need to generate more than one ‘value’ and should include evaluation of other components of the upper motor neurone syndrome. There is therefore a need for standardized protocols for ‘best practice’ in application of Spasticity measurement tools and scales.
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are we underestimating the clinical efficacy of botulinum toxin type a quantifying changes in Spasticity strength and upper limb function after injections of botox to the elbow flexors in a unilateral stroke population
2002Co-Authors: Anand D Pandyan, Philippe Vuadens, Frederike Van Wijck, Sandra C Stark, G R Johnson, Michael P BarnesAbstract:Objective: To quantify the clinical efficacy of botulinum toxin type A in treating elbow flexor Spasticity in a unilateral stroke population. Location: A Spasticity clinic at a regional neurological rehabilitation centre.Study design: A convenience sample longitudinal study. Fourteen subjects with elbow flexor Spasticity secondary to a stroke were recruited. Two repeated measures, one before and another four weeks after treatment, were taken to quantify clinical efficacy.Outcome measures: Elbow flexor Spasticity was simultaneously rated with the modified Ashworth scale (MAS) and quantified by measuring the surface EMG from the flexors using a custom-built device. Strength at the elbow (isometric), grip strength and upper limb function (Action Research Arm test) were also assessed.Treatment: Injections of botulinum toxin type A (Botox®) to the m.biceps brachii (mean dose 70 U), m.brachioradialis (mean dose 56.5 U) and m.flexor digitorum longus (mean dose 83.3 U).Results: Following treatment, Spasticity (as...
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a review of the properties and limitations of the ashworth and modified ashworth scales as measures of Spasticity
1999Co-Authors: Anand D Pandyan, G R Johnson, Michael P Barnes, Christopher Price, Richard Curless, Helen RodgersAbstract:Background: The Ashworth Scale and the modified Ashworth Scale are the primary clinical measures of Spasticity. A prerequisite for using any scale is a knowledge of its characteristics and limitations, as these will play a part in analysing and interpreting the data. Despite the current emphasis on treating Spasticity, clinicians rarely measure it.Objectives: To determine the validity and the reliability of the Ashworth and modified Ashworth Scales.Study design: A theoretical analysis following a structured literature review (key words: Ashworth; Spasticity; Measurement) of 40 papers selected from the BIDS-EMBASE, First Search and Medline databases.Conclusions: The application of both scales would suggest that confusion exists on their characteristics and limitations as measures of Spasticity. Resistance to passive movement is a complex measure that will be influenced by many factors, only one of which could be Spasticity. The Ashworth Scale (AS) can be used as an ordinal level measure of resistance to pa...
A P Moore - One of the best experts on this subject based on the ideXlab platform.
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a double blind placebo controlled study of botulinum toxin in upper limb Spasticity after stroke or head injury
2000Co-Authors: S J Smith, E Ellis, S White, A P MooreAbstract:Objective: To assess dose–response relationships to a single dose of botulinum toxin ‘A’ in upper limb Spasticity associated with stroke or head injury.Design: A double-blind placebo-controlled randomized dose ranging study.Setting: A regional centre for neuroscience and a neurorehabilitation outpatient clinic.Subjects: Twenty-one hemiplegic patients with troublesome upper limb Spasticity. Nineteen with stroke and two with head injury.Main outcome measures: Spasticity (modified Ashworth), range of movement, posture (postural alignment and finger curl), disability (upper body dressing time and Frenchay Arm Test), patient-reported global assessment scale.Results: Combining data from all doses of botulinum toxin there was a significant reduction in Spasticity at the wrist and fingers associated with a greater range of passive movement at the wrist and less finger curl at rest. There was a tendency for a further reduction in Spasticity at elbow and wrist to occur with increasing dose but not for finger spasti...
