• Physical Therapy Korea
• /
• v.1 no.1
• /
• pp.1-9
• /
• 1994

This study was performed to determine the inter-rater reliability of manual tests of elbow, knee flexor, and ankle dorsiflexor muscle spasticity graded on the Modified Ashworth Scale. Two raters each independently graded the spasticity of 32 patients with intracranial lesions after moving the paretic limb passively through the available range of motion. The patients were asked to simultaneously squeeze therapeutic putty with their non-paretic hand for reinforcement. The ratings were compared by the Wilcoxon matched pairs signed-rank test and by the Kendall's coefficient of rank(tau) correlation. There was singificant correlation between two raters for spasticity at the elbow, knee flexor, and ankle dorsiflexor. The correlations of the two raters ranged from .6746 to .9308. The highest correlation was for the elbow with reinforcement and the lowest was for the knee without reinforcement. Poorer correlation was evident in the knee joint. The positive results of this study encourage the continued use of manual tests of muscle spasticity, using the Modified Ashworth Scale.

• The Journal of Korean Physical Therapy
• /
• v.22 no.4
• /
• pp.29-33
• /
• 2010

Purpose: The purpose of this study was to assess and compare the reliability of the Modified Tardieu Scale (MTS) with the Modified Ashworth Scale (MAS) in patients with hemiplegia. Methods: Two experienced physical therapists examined twenty six patients (17 male and 9 female) with an age range of 19-83 years (mean=51.9 SD=15.2). They assessed the elbow flexor/extensor muscle spasticity in the affected side. Interand intra-rater reliability of the MAS and the MTS were calculated using kappa statistics. Intraclass correlation coefficient (ICC) was calculated to determine the inter- and intra-rater reliability of the angle of muscle reactions (R2-R1). Results: The intra-rater reliability of the MAS (K=0.39-0.55) and MTS (K=0.33-0.55) was fair to moderate. The inter-rater reliability was significantly higheras measured with MTS (K=0.54-0.66) in comparison with MAS (K=0.52). Intra-rater reliability of R2-R1 was moderate to almost perfect (ICC=0.52-0.86), and inter-rater reliability was substantial (ICC=0.74-0.76). Conclusion: The MTS provides higher inter-rater reliability compared with the MAS in hemiplegia patient analysis, but intra-rater reliability of both scales was not significantly different. Thus further research is needed to examine not only reliability, but also validity of these measurement systems.

• Journal of Acupuncture Research
• /
• v.17 no.2
• /
• pp.209-220
• /
• 2000

Spasticity, an abnormal increase in resting muscle tone, is one of the most common symptoms of stroke, and its management is becoming a major issue in rehabilitation. The aims of this study are to determine the effects of electroacupuncture(EA), TENS and neuromuscular electric stimulation(NMES) on spasticity, as well as the possibility of tissue comliance method as a spasticity scale. 45 stroke patients participated in a study of the effects on hemiplegic spasticity of EA, TENS and NMES. Spasticity was measured by modified Ashworth scale on the upper extremity and tissue compliance measurement, penetration mm/kg, on Susamni(LI10) area at just before and after stimulation, and 30 minutes, 1 hour, 2 hours and 24 hours after stimulation. The acupuncture points were applied to Kokchi(LI11), Susamni(LI10), Hapkok(LI4) and Oegwan(TE5) of the affected limb. The electrodes were placed unilaterally on LI11 to LI10 and TE5 to LI4. EA with biphasic wave, 60Hz, 0.4 msec pulse duration and low intensity was applied continuously for 20 minutes. TENS with high frequency, low intensity was applied. NMES was applied with spasticity program for 20 minutes. Each electric stimulation was done on extensor muscles group of forearm for 20 minutes. EA and NMES groups were found to produce a statistically significant decrease(p〈0.05) of spasticity and these effects lasted up to 30 minutes after stimulation. There was no definite correlation between the modified Ashworth scale and tissue compliance measurement. But tissure compliance method was found to be possible as a quantitative measurement on spasticity. There was no significant correlation between the effects of EA and NMES and the characteristics of patient, but significant correlation between the effects of EA and NMES and the modified Ashworth scale.

• Journal of the Korean Society of Physical Medicine
• /
• v.5 no.3
• /
• pp.477-485
• /
• 2010

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.

• Transactions of the Korean Society of Mechanical Engineers B
• /
• v.41 no.2
• /
• pp.125-133
• /
• 2017

This paper presents the inter-rater reliability of finger spasticity assessment tested realized by using finger simulator that mimics finger spasticity of patients after a stroke. For controlling the simulator torque, finger spasticity was modeled, and the model parameters were obtained by measuring quantitative data while grading based on Modified Ashworth Scale (MAS). A robotic finger simulator was designed for mimicking finger spasticity. Evaluation of this simulator with the help of seven rehabilitation doctors showed that the simulator had a Cohen's kappa value of 0.619 for Metacarpophalangeal Joint and 0.514 for Proximal Interphalangeal Joint. Fleiss' kappa between raters is 0.513 for Metacarpophalangeal Joint and 0.486 for Proximal Interphalangeal Joint. Therefore, the spasticity assessment made by MAS grade system is not reliable owing to the subjectivity of the assessment. The proposed robotic simulator can be used as a training tool for improving the reliability of the spasticity assessment.

• The Journal of Korean Academy of Sensory Integration
• /
• v.14 no.2
• /
• pp.1-10
• /
• 2016

Objective: This study aims investigating the effects of functional electrical stimulation (FES) on hand function of children with spastic cerebral palsy. Methods: The participants of this study are 20 children with spastic cerebral palsy aged between 11 to 16 years old. All the subjects underwent 24 sessions of FES during 8 weeks. Each FES was 20 minutes per session, and 3 sessions of FES were provided in a week. Measurements used to assess hand function are Jebsen Hand Function Test, Modified Ashworth Scale and 3D Motion Analysis. After establishment of the baseline for each client by all the measurements, reevaluations were performed every 2 weeks using Jebsen Hand Function Test and the Modified Ashworth Scale. The 3D Motion Analysis was performed only before- and after the 8 weeks of FES treatment. Results: After the FES, there was significant decrease in completed time for the all 6 subtasks of Jebsen Hand Function Test were (p<.05) and also significant decrease in spasticity score of Modified Ashworth Scale as well (p<.05). 3D Motion Analysis showed that the hand tapping and the finger tapping has been significantly improved (p<.05), and the pronation-supination movement of lower arm has been significantly improved as well. Conclusion: Based on the results of this study, it is evidenced that functional electrical stimulation is effective treatment for hand function of children with cerebral palsy. For future research, it is recommended to examine various protocols of FES including impact of long-term application.

• International Journal of Contents
• /
• v.17 no.2
• /
• pp.20-31
• /
• 2021

This study aimed to pilot test a newly developed bilateral upper limb rehabilitation training program for improving the upper limb function of individuals with chronic stroke using a visual feedback method. The double-group pretest-posttest design pilot study included 10 individuals with chronic stroke (age >50 years). The intervention (four weekly meetings) consisted of five upper limb training protocols (wrist extension; forearm supination and pronation; elbow extension and shoulder flexion; weight-bearing shift; and shoulder, elbow, and wrist complex movements). Upper limb movement function recovery was assessed with the FuglMeyer Assessment of the Upper Extremity, the Wolf Motor Function Test, the Trunk Control Test, the modified Ashworth Scale, and the visual analog scale at baseline, immediately after, and four weeks after the intervention. The Fatigue Severity Scale was also employed. The Fugl-Meyer Assessment of the Upper Extremity and Wolf Motor Function Test showed significant improvement in upper limb motor function. The Trunk Control Test results increased slightly, and the modified Ashworth Scale decreased slightly, without statistical significance. The visual analog scale scores showed a significant decrease and the Fatigue Severity Scale scores were moderate or low. The bilateral upper limb training program using the visual feedback method could result in slight upper limb function improvements in individuals with chronic stroke.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.13 no.3
• /
• pp.1129-1137
• /
• 2012

The aim of this study was to find useful parameters of the between myotonometer and surface electromyography(sEMG) on the medialis gastrocnemius of stroke patients and investigate between these parameters and modified Ashworth scale(MAS) relationship. 5 years clinical experience physical therapist using the Modified Ashworth Scale(MAS) was selected 15 patients with ankle spasticity and divided randomly MAS2, MAS3, MAS4 groups. Myotonometer and sEMG was measured during relaxed and maximum voluntary contractions of the gastrocnemius muscle. The results of this study, the higher MAS score was the lowered the relaxation and contraction state tissue compliance and muscle activity and in the correlation analysis the higher MAS score during voluntary contraction in the cylinder receiving low-intensity correlation could see that increased than relaxation. Therefore, the myotonometer is a useful clinical and research tool with spasticity muscle and can provide objective quantitative data about the efficacy of physical therapy interventions.

• The Journal of Korean Physical Therapy
• /
• v.13 no.1
• /
• pp.161-174
• /
• 2001

The purpose of this study was to reduce the spasticity of plantarflexion. the subjects of this study were 30 hemiplegic patients with stroke who received of physical therapy in JinJu o o hospital from May to July 2000. the subjects were divided into three groups(FES groups 10, FES + tilt table-wedge board standing groups 10, & tilt table-wedge board standing groups 10). The result were as follow 1. FES therapy was a effective method to reduce the spasticity of plantarflexor. there was a significant difference in modified Ashworth scale(p<.01). there was a significant difference in weight bearing ratio between nonparetic and paretic side(p<.01). 2. Tilt table-wedge board standing therapy was a effective method to reduce the spasticity of plantarflexor to a degree but there was a no significant difference in modified Ashworth scale(p<.05). there was a significant difference in weight bearing ratio between nonparetic and paretic side(p<.01). 3. Tilt table-wedge board standing therapy + FES therapy was a effective method to reduce the spasticity of plantarflexor. there was a significant difference in modified Ashworth scale(p<.01). there was a significant difference in weight bearing ratio between nonparetic and paretic side(p<.01) 4. There was a significant difference in weight bearing ratio between nonparetic and paretic side according to the grade spasticity(p<.01). 5. For normal persons vs hemiplegic patients, there was a significant different in weight bearing ratio between nonparetic and paretic side(experimental subjects 1 p<.01, experimental subjects 2 p<.01, control subjects p<.05).

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
• /
• v.11 no.1
• /
• pp.11-28
• /
• 2005

Spasticity has been defined as "a motor disorder characterized by a velocity-dependent increased in tonic stretch reflexes with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex, as one components of the upper motorneuron syndrome". Spasticity is one of the common symptoms of stroke patients and frequently interferes with the motor functions such as gait, posture and activities of daily living. Therefore, its management is becoming a major issue in physical therapy. The purpose of this study was to determined the effects of reciprocal inhibition by isometric contraction of pre-tibia muscle on spasticity in hemiplegic patients through Hoffmann reflex. The subjects were consisted 45 patients who had hemiplegia due to stroke. All subjects randomly assigned to 3 group: manual reciprocal inhibition program group(manual group), neuromuscular electrical stimulation group(NMES group) and control group. The manual group received voluntary isometric contraction of pre-tibia muscle. The NMES group received neuromuscular electrical stimulation on tibialis anterior. The control group was not received any therapeutic intervention. Before and after experiments, Hoffmann reflex, M-wave and Modified Ashworth scale was measure in all patients. The data of 30 patients who complete experimental course were statistically analysed. Modified Ashworth scale were significantly decreased after experiment in manual group(p<.01). The Hmax/Mmax ratios were significantly decreased after experiment in manual group(p<.o1). There were no statistical difference between pre-test and post-test with modified Ashworth scale in NMES group(p>.01). There were no statistical difference between pre-test and post-test with Hmax/Mmax ratios in NMES group(p>.01). There were no statistical difference between pre-test and post-test with modified Ashworth scale in control group(p>.01). There were no statistical difference between pre-test and post-test with Hmax/Mmax ratios in control group(p>.01). The present results revealed that reciprocal inhibition which produced by voluntary isometric contraction of pre-tibia muscle can be reduce spasticity of gastrocnemius. Therefore, reciprocal inhibition is useful to improve functional activities in hemiplegic patient. Further study should be done to analyse the effects of intervention duration of reciprocal inhibition, appropriate muscle contraction, optimal time to apply the reciprocal inhibition in more long period.