Reliability of Modified Ashworth Scale as compared to Modified Tardieu Scale on Assessment of Lower Limb Spasticity in Children with Diplegic Cerebral Palsy
Reliability of Ashworth Scale in Cerebral Palsy
DOI:
https://doi.org/10.55735/hjprs.v3i7.183Keywords:
diplegic cerebral palsy, intra-rater reliability, lower limb spasticity, muscle toneAbstract
Background: Tools such as the Modified Ashworth scale used to score muscle resistance upon rapid stretch force application, and the modified Tardieu scale used to measure velocity-dependent spasticity, aid in the diagnosis. The need for reliable and standardized measurement tools is emphasized, as many instruments used to measure spasticity do not align with the concept of spasticity and lack standardization. Objective: To measure the reliability of the modified Ashworth scale as compared to the modified Tardieu scale on the assessment of lower limb spasticity in children with diplegic cerebral palsy. Methods: This observational study was conducted in a special needs school in Pakistan and utilized a non-probability purposive sampling method. Inclusion criteria for the study were 30 children diagnosed with spastic cerebral palsy, aged from 9 months to 25 years, of both gender, possessing upper trunk control, being able to sit in a wheelchair, and having upper limb control. Exclusion criteria included children with athetoid, ataxic, or mixed cerebral palsy and those on antispastic drugs. Data were collected through a proforma record sheet. A physical therapist utilized the modified Ashworth and the modified Tardieu scale to assess muscle tone and degree of spasticity respectively. The reliability of both the modified Ashworth and Tardieu scales was determined through the test-retest method with kappa statistics utilized for calculation. Additionally, percent agreement was calculated to determine intra-rater reliability. Results: For the modified Ashworth scale, substantial intra-rater reliability was observed between the first and second attempts, with a kappa value of k=.776 (95% CI, 0.705-0.847). For the modified Tardieu scale, even higher intra-rater reliability was found with a kappa value of k=.894 (95% CI, 0.839-0.949). Conclusion: The intra-rater reliability of the modified Tardieu scale was higher than that of the modified Ashworth scale for measuring lower limb spasticity in spastic diplegic cerebral palsy. It also indicated that the reliability of both scales could be influenced by the assessing professional's skills, underscoring the importance of rigorous training for improved scale reliability, accurate diagnoses and effective treatments.
References
McIntyre S, Goldsmith S, Webb A, et al. Global prevalence of cerebral palsy: A systematic analysis. Developmental medicine and child neurology 2022; 64(12): 1494-506.
Paul S, Nahar A, Bhagawati M, Kunwar AJ. A Review on Recent Advances of Cerebral Palsy. Oxidative medicine and cellular longevity 2022; 2022: 2622310.
Demont A, Gedda M, Lager C, et al. Evidence-Based, Implementable Motor Rehabilitation Guidelines for Individuals With Cerebral Palsy. Neurology 2022;99(7):283-97.
Friedman JM, van Essen P, van Karnebeek CDM. Cerebral palsy and related neuromotor disorders: Overview of genetic and genomic studies. Molecular genetics and metabolism 2022; 137(4): 399-419.
Schirmbeck GH, Sizonenko S, Sanches EF. Neuroprotective Role of Lactoferrin during Early Brain Development and Injury through Lifespan. Nutrients 2022;
(14).
Hansen ML, Pellicer A, Hyttel-Sørensen S, et al. Cerebral Oximetry Monitoring in Extremely Preterm Infants. The New England journal of medicine 2023;
(16): 1501-11.
Curioni CC, Mocellin MC, Tavares MDS, et al. Effectiveness of nutritional interventions to prevent nonprogressive congenital and perinatal brain injuries: a systematic review and meta-analysis of randomized trials. Nutrition reviews 2022; 80(11): 2136-53.
Pahwa PK, Mani S. Current Profile of Physical Impairments in Children with Cerebral Palsy in Inclusive Education Settings: A Cross-Sectional Study. Journal of neurosciences in rural practice 2022; 13(3): 424-30.
Chen A, Dyck Holzinger S, Oskoui M, Shevell M, Registry CCP. Losing a diagnosis of cerebral palsy: a comparison of variables at 2 and 5 years. Developmental Medicine & Child Neurology 2020; 62(1): 83-8.
Chen J, Or CK, Chen T. Effectiveness of Using Virtual Reality-Supported Exercise Therapy for Upper Extremity Motor Rehabilitation in Patients With Stroke: Systematic Review and Meta-analysis of Randomized Controlled Trials. Journal of medical Internet research 2022; 24(6): e24111.
Harb A, Kishner S. Modified Ashworth Scale. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Stephen Kishner declares no relevant financial relationships with ineligible companies.: StatPearls Publishing Copyright © 2023, StatPearls Publishing LLC.; 2023.
Tufo T, Ciavarro M, Di Giuda D, Piccininni C, Piano C, Daniele A. Spinal cord stimulation may improve gait and cognition in hereditary spastic paraplegia with mental retardation: a case report. Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology 2023; 44(3): 961-6.
Michael-Asalu A, Taylor G, Campbell H, Lelea L-L, Kirby RS. Cerebral palsy: diagnosis, epidemiology, genetics, and clinical update. Advances in pediatrics 2019; 66: 189-208.
Aravamuthan BR, Fehlings D, Shetty S, et al. Variability in cerebral palsy diagnosis. Pediatrics 2021; 147(2).
Schlough K, Andre K, Owen M, et al. Differentiating between idiopathic toe walking and cerebral palsy: a systematic review. Pediatric Physical Therapy 2020; 32(1): 2-10.
Miller F. Foot Deformities Impact on Cerebral Palsy Gait. Cerebral Palsy 2020: 1517-32.
Ali A, Yalçın R, Ünlüer-Gümüştaş A. Cranial MR characteristics of Cerebral Palsy cases and correlation of findings with clinical results. The Turkish Journal of Pediatrics 2019; 61(4): 525-37.
Cameron Dwyer D, Sean Norkus D, DIBCN D. Manual Therapy and Cerebral Palsy: A Narrative Literature Review. Journal of the International Academy of Neuromusculoskeletal Medicine; 20(1).
Seyyar GK, Aras B, Aras O. Trunk control in children with ataxic cerebral palsy. Perceptual and Motor Skills 2019; 126(5): 815-27.
Al-Mosawi AJ. New therapies for the treatment of ataxic cerebral palsy caused by kernicterus. EC Clinical and Medical Case Reports 2020; 3(4): 26-31.
Hacker ML, Ploucher S, Naik AG, et al. A simple bedside screening tool for spasticity referral. Clinical Interventions in Aging 2020: 655-62.
Vespa E, Farina DA, Kahrilas PJ, et al. Identifying spastic variant of type II achalasia after treatment with high‐resolution manometry and FLIP Panometry. Neurogastroenterology & Motility 2023: e14552.
Lehdonvirta V, Oksanen A, Räsänen P, Blank G. Social media, web, and panel surveys: using non‐probability samples in social and policy research. Policy & internet 2021; 13(1): 134-55.
Stadskleiv K. Cognitive functioning in children with cerebral palsy. Developmental Medicine & Child Neurology 2020; 62(3): 283-9.
Novak I, Morgan C, Fahey M, et al. State of the evidence traffic lights 2019: systematic review of interventions for preventing and treating children with cerebral palsy. Current neurology and neuroscience reports 2020; 20: 1-21.
Vadivelan K, Sekar P, Sruthi SS, Gopichandran V. Burden of caregivers of children with cerebral palsy: an intersectional analysis of gender, poverty, stigma, and public policy. BMC public health 2020; 20: 1-8.
Berelowitz S, Franzsen D. Visual Perceptual Deficits in Different Types of Cerebral Palsy. South African Journal of Occupational Therapy 2021; 51(1): 18-26.
Pérez J, Díaz J, Garcia-Martin J, Tabuenca B. Systematic literature reviews in software engineering—enhancement of the study selection process using Cohen’s Kappa statistic. Journal of Systems and Software 2020; 168: 110657.
Yoo M, Ahn JH, Rha D-w, Park ES. Reliability of the Modified Ashworth and Modified Tardieu Scales with Standardized Movement Speeds in Children with Spastic Cerebral Palsy. Children 2022; 9(6): 827.
Singh A, Singh M. Comparison of Modified Ashworth Scale and Modified Tardieu Scale on Assessment of Lower Limb Spasticity in Hemiplegic and Diplegic Cerebral Palsy. Indian Journal of Public Health 2019; 10(11): 2767.
Esquenazi A, Wein TH, Ward AB, Geis C, Liu C, Dimitrova R. Optimal muscle selection for onabotulinumtoxina injections in poststroke lower-limb spasticity: a randomized trial. American Journal of Physical Medicine & Rehabilitation 2019; 98(5): 360-8.
Esquenazi A, Wein TH, Ward AB, Geis C, Liu C, Dimitrova R. Optimal Muscle Selection for OnabotulinumtoxinA Injections in Poststroke Lower-Limb Spasticity: A Randomized Trial. American Journal of Physical Medicine & Rehabilitation 2019; 98(5).
Downloads
Published
How to Cite
License
Copyright (c) 2023 The Healer Journal of Physiotherapy and Rehabilitation Sciences
This work is licensed under a Creative Commons Attribution 4.0 International License.
CC BY
