The influence of contractures and variation in measurement stretching velocity on the reliability of the Modified Ashworth Scale in patients with severe brain injury.
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.
Mehrholz
Jan
J
Department of Early Rehabilitation, Klinik Bavaria, Kreischa, Germany.
Major
Yvonne
Y
Meissner
Daniel
D
Sandi-Gahun
Sahr
S
Koch
Rainer
R
Pohl
Marcus
M
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