title: An investigation into the agreement between clinical, biomechanical and neurophysiological measures of spasticity.
abstract: OBJECTIVE
  To quantify agreement between three clinically usable methods of measuring spasticity.
  
  
  METHODS
  Patients with a first stroke who had no useful functional movement in the upper limb within six weeks from stroke onset were eligible to participate. Spasticity at the wrist joint was simultaneously measured using three methods, during an externally imposed passive stretch at two (uncontrolled) displacement velocities. The measures used were a common clinical measure (modified Ashworth Scale), a biomechanical measure (resistance to passive movement) and a neurophysiological measure (muscle activity).
  
  
  RESULTS
  One hundred patients (54 men and 46 women) with a median age of 74 years (range 43-91) participated. Median time since stroke was three weeks (range 1-6), the right side was affected in 52 patients and the left in 48 patients. Based on muscle activity measurement, 87 patients had spasticity. According to the modified Ashworth score 44 patients had spasticity. Sensitivity of modified Ashworth score, when compared with muscle activity recordings, was 0.5 and specificity was 0.92. Based on muscle activity patterns, patients could be classified into five subgroups. The biomechanical measures showed no consistent relationship with the other measures.
  
  
  CONCLUSIONS
  The presentations of spasticity are variable and are not always consistent with existing definitions. Existing clinical scales that depend on the quantification of muscle tone may lack the sensitivity to quantify the abnormal muscle activation and stiffness associated with common definitions of spasticity. Neurophysiological measures may provide more clinically useful information for the management and assessment of spasticity.
authors.affiliation: Research Institute for Life Course Studies, University of Keele, Keele, UK.
authors.forename: Shweta
authors.initials: S
authors.lastname: Malhotra
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Cousins
authors.forename: Anthony
authors.initials: A
authors.lastname: Ward
authors.forename: Charles
authors.initials: C
authors.lastname: Day
authors.forename: Peter
authors.initials: P
authors.lastname: Jones
authors.forename: Christine
authors.initials: C
authors.lastname: Roffe
authors.forename: Anand
authors.initials: A
authors.lastname: Pandyan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D004576:Electromyography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D009129:Muscle Tonus; D010243:Paralysis / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications*