title: The influence of contractures and variation in measurement stretching velocity on the reliability of the Modified Ashworth Scale in patients with severe brain injury.
abstract: OBJECTIVE
  To determine the influence of contractures and different stretching velocities on the reliability of the Modified Ashworth Scale (MAS) in patients with severe brain injury and impaired consciousness.
  
  
  METHODS
  Cross-section observational study.
  
  
  METHODS
  A rehabilitation centre for adult persons with neurological disorders.
  
  
  METHODS
  Fifty patients with impaired consciousness due to severe cerebral damage of various aetiologies. MEASUREMENT PROTOCOL: Three experienced and trained medical professionals rated each patient in a randomized order once daily for two consecutive days. Shoulder, elbow, wrist, knee and ankle spasticity were assessed by the use of the MAS with different stretching velocities. The presence of contractures was assessed by a goniometer.
  
  
  METHODS
  Retest and inter-rater reliability (k(w) = weighted kappa) of the MAS.
  
  
  RESULTS
  The retest reliability of the MAS was good (shoulder joints (k(w) 0.74), elbow joints (k(w) 0.74), wrist joints (k(w) 0.72), knee joints (k(w) 0.72), ankle joints (k(w) 0.77)) and the inter-rater reliability was moderate (shoulder joints (k(w) 0.49), elbow joints (k(w) 0.52), wrist joints (k(w) 0.51), knee joints (k(w) 0.54) ankle joints (k(w) 0.49)). The presence of contractures significantly influenced the reliability of MAS in shoulder and wrist joints. No influence of stretching velocity on the reliability of the MAS was found.
  
  
  CONCLUSIONS
  In patients with impaired consciousness due to severe brain injury the MAS has good retest, but only limited inter-rater, reliability. The presence of contractures may influence reliability of the MAS, but stretching velocity does not.
authors.affiliation: Department of Early Rehabilitation, Klinik Bavaria, Kreischa, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Mehrholz
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Major
authors.forename: Daniel
authors.initials: D
authors.lastname: Meissner
authors.forename: Sahr
authors.initials: S
authors.lastname: Sandi-Gahun
authors.forename: Rainer
authors.initials: R
authors.lastname: Koch
authors.forename: Marcus
authors.initials: M
authors.lastname: Pohl
mesh_terms: D001930:Brain Injuries / Q000145:classification* / Q000534:rehabilitation; D015444:Exercise; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction; D009128:Muscle Spasticity / Q000145:classification / Q000534:rehabilitation; D015203:Reproducibility of Results; D012720:Severity of Illness Index