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Reliability of the Modified Modified Ashworth Scale for the Muscle Tone of Poststroke Patients  

Kim, Tae-Ho (Department of Physical Therapy, Daegu Health College)
Kim, Yong-Wook (Department of Physical Therapy, Jeonju University)
Publication Information
Journal of the Korean Society of Physical Medicine / v.5, no.3, 2010 , pp. 477-485 More about this Journal
Abstract
Purpose : The clinical scale to assess spasticity of muscle was wildly used the modified Ashworth scale (MAS). But reliability of the MAS has been controverted for ambiguity among the grades. The purpose of this study was to establish the inter-rater reliability of the modified MAS (MMAS) translated into Korean in stroke patients. Methods : Twenty-five patients (sixteen men and nine women) with hemiplegia (ten right and fifteen left) were measured by two raters who were physical therapist in the rehabilitation hospital. The raters assessed spasticity of shoulder adductor, elbow flexor, wrist flexor, hip adductor, knee extensor, and ankle plantar flexor in the same patients according to ratings criteria of the MAS and the MMAS. Results : For the inter-rater reliability of the MAS, two raters agreed on 57.3% and the Kappa values were moderate ($\kappa$=0.41) between two rater. The inter-rater reliability of the MAS was fair for the wrist flexor and the hip adductor and moderate for the other muscles. The intra-rater reliability was good for the shoulder adductor and the knee extensor and moderate for the other muscles. For the inter-rater reliability of the MMAS, two raters agreed on 84.7% and the Kappa values were good ($\kappa$=0.78) between two rater. The inter-rater reliability of the MMAS was moderate for the hip adductor, and good for the shoulder adductor and the wrist flexor, and very good for the other muscles. The intra-rater reliability was good for the wrist flexor and the hip adductor and very good for the other muscles. Conclusion : This study suggests that the MMAS translated into Korean is reliable test scale for the spasticity with stroke patients in the clinical field.
Keywords
Modified Ashworh Scale; Modified Modified Ashworh Scale; Reliability; Spasticity; Stroke;
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Times Cited By KSCI : 2  (Citation Analysis)
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1 Ansari NN, Naghdi S, Younesian P, et al. Inter-and intrarater reliability of the Modified Modified Ashworth Scale in patients with knee extensor poststroke spasticity. Physiother Theory Pract. 2008b;24(3):205-13.   DOI   ScienceOn
2 이충휘, 구애련 경련성(spasticity) 평가를 위한 Modified Ashworth Scale의 측정자간 신뢰도. 한국전문물리치료학회지. 1994;1(1):1-9.
3 박병규, 신용범, 조시철 등. 뇌졸중 환자의 경직에 대한 전기자극의 치료효과. 대한재활의학회지.2003; 27(5):647-51.
4 Ansari NN, Naghdi S, Moammeri H, et al. Ashworth Scales are unreliable for the assessment of muscle spasticity. Physiother Theory Pract. 2006;22(3): 119-25.   DOI   ScienceOn
5 성덕현, 김종문, 이강우 등. 등속성 근력계를 이용한 슬관절 신근 경직의 정량적 평가. 대한재활의학회지. 2002;26(3):321-6.
6 김대호, 정이정. 뇌졸중 후 강직(spasticity) 평가를 위한 Tone Assessment Scale의 신뢰도. 한국전문물리치료학회지. 2002;9(2): 133-44.
7 Barnes MP, Johnson GR. Upper motor neurone syndorme and spasticty: clinical management and neurophysiology. New York. Cambridge University. NY. 2001.
8 Becher J, Harlaar J, Lankhorst GJ, et al. Measurement of impaired muscle function of the gastrocnemius, soleus, and tibialis anterior muscle in spastic hemiplegia: a preliminary study. J Rehabil Res Dev. 1998;35(3):314-26.
9 Blackburn M, van Vliet P, Mockett SP. Reliability of measurements obtained with the Modified Ashworth Sclae in the lower extremities of people with stroke. Phys Ther. 2002;82(1):25-34.
10 Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987;67(2):206-7.
11 Sloan RL, Sinclair E, Thompson J, et al. Inter-rater reliability of the modified Ashworth scale for spasticity in hemiplegic patients. Int J Rehabil Res. 1992;15(2):158-61.   DOI
12 Allison SC, Abraham LD, Petersen CL. Reliability of the Modified Ashworth Scale in the assessment of plantarflexor muscle spasticity in patients with traumatic brain injury. Int J Rehabil Res. 1996;19 (1):67-78.   DOI
13 Ansari NN, Naghdi S, Arab TK, et al. The interrater and intrarater reliability of the Modified Ashworth Scale in the assessment of muscle spasticity: limb and muscle group effect. NeuroRehabilitation. 2008a;23(3):231-7.
14 Ansari NN, Naghdi S, Hasson S, et al. Assessing the reliability of the Modified Modified Ashworth Scale between two physiotherapists in adult patients with hemiplegia. NeuroRehabilitation. 2009;25(4): 235-40.
15 Pandyan AD, Price CI, Barnes MP, et al. A biomechanical investigation into the validity of the Modified Ashworth Scale as a measure of elbow spasticity. Clin Rehabil. 2003; 17(3):290-4.   DOI   ScienceOn
16 Rekand T. Clinical assessment and management of spasticity: a review. Acta Neuro Scand. 2010;122 (Suppl 190):62-6.
17 Stillmann B, McMeeken J. A video-based version of the pendulum test: technique and normal response. Arch Phys Med Rehabil. 1995;76(2):166-76.   DOI   ScienceOn
18 Young RR. Spasticity: a review. Neurology. 1994;44 (11 Suppl 9):S12-S20.
19 Naghdi S, Ansari NN, Azarnia S, et al. Interrater reliability of the Modified Modified Ashworth Scale (MMAS) for patients with wrist flexor muscle spasticity. Physiother Theory Pract. 2008; 24(5):372-79.   DOI   ScienceOn
20 Lance JW. Pathophysiology of spasticity and clinical experience with baclofen. In: Lance JW, Feldmann RG, Koella WP. Spasticity: disordered motor control. Chicago, Year Book Medical Pub. 1980.
21 Clopton N, Dutton J, Featherston T, et al. Interrater and intrarater reliability of the Modified Ashworth Sclae in children with hypertonia. Pediatr Phys Ther. 2005;17(4):268-74.   DOI   ScienceOn
22 Bodin PG, Morris ME. Inter-rater reliability of the modified Ashworth scale for wrist flexor spasticity following stroke. 11th Congress. World Confederation of Physiotherapy. 1991;505-7.
23 Brennan P, Silman A. Statistical methods for assessing observer variability in clinical measures. BMJ. 1992;304(6840): 1491-4.
24 Butler PB, Thompson N, Major RE. Improvement in walking performance of children with cerebral palsy: preliminary results. Dev Med Child Neurol. 1992;34(7):567-76.
25 Ghotbi N, Ansari NN, Naghdi S, et al. Inter-rater reliability of the Modified Modified Ashworth Scale in assessing lower limb muscle spasticity. Brain Inj. 2009;23(10):815-9.