The reliability measurements of lateral scapular slide test at three different degrees of shoulder joint abduction.

BACKGROUND: Lateral scapular slide test (LSST) quantitatively measures the distance between thoracic spine (T7) and inferior angle of scapula. OBJECTIVE: In this study, the intra-rater reliability, inter-rater reliability and diagnostic accuracy of LSST were measured using a caliper. METHODS: Three measurements of each test position were obtained bilaterally. Intraclass correlation coefficient (ICC) (2.1), 95% CI and 2 SEMs were calculated for intra-rater and inter-rater reliability of the absolute scapular distance. Sensitivity, specificity, positive and negative likelihood ratios were determined. RESULTS: 27 people with and 30 people without shoulder pain participated. The mean age (SD) for the participant was 47.7 (11.6) years and 33.5 (11.7) years, respectively. The ICCs for intra-rater reliability were high. A range of poor to good ICCs was found for inter-rater reliability. The 2 SEMs ranged from 4.6 to 7.9 mm for intra-rater reliability and from 6.8 to 13.4 mm for inter-rater reliability for people with shoulder pain. Positive and negative likelihood ratios from 0.94 to 1.22 and from 0.21 to 2.5, respectively, were demonstrated. CONCLUSION: SST did not show a consistent high reliability. The diagnostic accuracy of the LSST was low, which questions the clinical importance of the tests outcomes.

The correlation between Modified Ashworth Scale scores and the new index of alpha motoneurones excitability in post-stroke patients.

The Modified Ashworth Scale (MAS) is currently a widely used clinical scale to evaluate muscle spasticity. However, it lacks reliability and the validity, of the MAS as a clinical measure of muscle spasticity has been challenged. The aim of the present study was to examine the validity of the MAS in patients with wrist flexor spasticity after stroke by using the Hslope/Mslope (Hslp/Mslp) ratio as the new index of alpha motoneuron excitability. Twenty-seven adult patients (14 women and 13 men) with first ever stroke resulting in hemiplegia with a mean (SD, range) age of 57.9 (11.6, 37-75) were included in the study. The main outcome measures were the MAS for the clinical assessment of spasticity, and the Hslp/Mslp for the neurophysiological evaluation. There was not a significant correlation between the MAS scores and Hslp/Mslp ratio (r = 0.38, p > 0.05). The mean of the Hslp/Mslp did not show a hierarchical increase with the MAS scores. The findings indicate that the MAS is not a valid and ordinal level measure of muscle spasticity.

Neurophysiological examination of the Modified Modified Ashworth Scale (MMAS) in patients with wrist flexor spasticity after stroke.

The Modified Modified Ashworth Scale (MMAS) is a clinical test for the measurement of spasticity. The aim of the present study was to examine the validity of the MMAS in patients with wrist flexor spasticity after stroke. 27 adult patients (14 women and 13 men) with first ever stroke resulting in hemiplegia with a mean (SD, range) age of 57.9 (11.6, 37-75) were included in the study. The outcome measures were the MMAS for the clinical assessment of spasticity, the Hslope/Mslope (Hslp/Mslp), and the H(max)/M(max) ratio for the neurophysiological evaluation. The mean of the Hslp/Mslp and the H(max)/M(max) were higher in patients with worse MMAS grades but the differences were not statistically significant. There was a significant positive correlation between the MMAS scores and Hslp/Mslp ratio as the new index of alpha motoneurone excitability or traditional index of H(max)/M(max) ratio (r = 0.39, p = 0.04). It is concluded that the MMAS to be a valid measure of spasticity after stroke.

Therapeutic ultrasound in the treatment of ankle plantarflexor spasticity in a unilateral stroke population: a randomized, single-blind, placebo-controlled trial.

Spasticity is a common and disabling symptom associated with Upper Motor Neuron Syndrome. The current methods of treatment for muscle spasticity have been claimed as unsatisfactory. Therapeutic ultrasound (US) is a common therapeutic modality in physiotherapy used for treating a wide variety of disorders. The aim of present study was to quantify the effects of continuous US on ankle plantarflexor spasticity in a randomized, single-blind, placebo-controlled trial. Twelve stroke patients (6 women and 6 men) randomly allocated to ultrasound (n = 6) or placebo (n = 6) groups. The patients were treated with either US or sham US for three days per week, every other day for 15 treatment sessions. The primary efficacy measures were the H-reflex and the Ashworth Scale (AS). In experimental group there was a significant reduction in the Hmax/Mmax ratio (p = 0.03). The Hmax/Mmax ratio was increased in the placebo group patients (p > 0.05). The difference between two groups was statistically significant (p = 0. 02). In both groups there was a reduction in the posttreatment AS scores. The Ashworth scores demonstrated statistically significant changes in the US group (p = 0.04). There was no statistical difference, however, when these two groups were compared (p > 0.05). Results from the present study show that treatment with US can reduce HmaxlMmax ratio as a measure of alpha motoneuron excitability and spasticity measure of AS in stroke patients with ankle plantarflexor spasticity.

A preliminary study into the criterion validity of the Modified Modified Ashworth Scale using the new measure of the alpha motoneuron excitability in spastic hemiplegia.

The Modified Ashworth Scale (MAS) is the most widely used clinical test for the measurement of muscle spasticity. This scale that suffers from limitations and lack of reliability and validity has recently been remodified. The aim of the present study is to investigate the criterion validity of the new Modified MAS(MMAS) in the upper limb in post-stroke hemiplegia, using the Hslope/Mslope (Hslp/Mslp) as a novel index of alpha motor neuron excitability. Prior to the validity study, the reliability of the MMAS was evaluated in 30 hemiplegic patients. The raters agreed on 23 patients (0. 76%). The MMAS had good inter-rater reliability (K= 0.63, SE = 0.11, p < 0.001) for the assessment of wrist flexors spasticity in hemiplegic patients. 12 adult patients (7 women and 5 men) with first ever stroke resulting in hemiplegia with a mean age of 58.9 +/- 11.9 years (range, 37-73) were included in the validity study. The outcome measures were the MMAS for the clinical assessment of spasticity, and the HslopelMslope and the Hmax/Mmax ratio for the electrophysiological evaluation. The results showed an increase in mean rank of Hslp / Mslp in patients with a score of 1, 2 or 3 on the MMAS. However, the difference among the groups was not significant (p > 0.05). There was also no relationship between the clinical scale of MMAS and either the traditional [Hmax / Mmax ratio (r = -0.06)] or the new index [Hslp / Mslp (r = 0.24)] of spinal excitability. This preliminary study recruited a small number of patients, and failed to confirm a linear correlation between these variables. A study with a large number of patients is suggested to clarify the outcome.

The effect of Bobath approach on the excitability of the spinal alpha motor neurones in stroke patients with muscle spasticity.

A clinical study was performed to evaluate the efficacy of the Bobath approach on the excitability of the spinal alpha motor neurones in patients with poststroke spasticity. Ten subjects ranging in age from 37 through 76 years (average 60 years) with ankle plantarflexor spasticity secondary to a stroke were recruited and completed the trial. They had physiotherapy according to Bobath concept for ten treatment sessions, three days per week. Two repeated measures, one before and another after treatment, were taken to quantify clinical efficacy. The effect of this type of therapy on the excitability of alpha motor neurones (aMN) was assessed by measuring the latency of the Hoffmann reflex (H-reflex) and the Hmax/Mmax ratio. The original Ashworth scale and ankle range of motion were also measured. The mean HmaxlMmax ratio on the affected side at baseline was high in the study patients. However, there were no statistically significant differences in the HmaxlMmax ratio or in the H-reflex latency between the baseline values and those recorded after therapy intervention. Before treatment, the HmaxlMmax ratio was significantly higher in the affected side than in the unaffected side. However, it was similar at both sides after treatment. Following treatment, the significant reduction in spasticity was clinically detected as measured with the original Ashworth scale. The ankle joint active and passive range of motion was significantly increased. In conclusion, Bobath therapy had a statistically significant effect on the excitability of the aMN in the affected side compared to the unaffected side in stroke patients with muscle spasticity.

A randomized, single blind placebo controlled clinical trial on the effect of continuous ultrasound on low back pain.

Low back pain (LBP) is a very common problem in primary care and a major cause of disability. There is no evidence for the efficacy of therapeutic modalities such as ultrasound in LBP In a randomized, single blind placebo controlled clinical trial, we aimed to evaluate the effect of continuous ultrasound (US) in patients with non specific LBP Of the fifty eight patients recruited, 10 patients (8 women and 2 men) randomly allocated to ultrasound (n=5) or placebo controlled (n=5) groups. The patients were treated by either US or sham-US for ten sessions, three days per week, every other day. The outcome measures were Functional Rating Index (FRI), Hmax/Mmax ratio and range of motion (ROM), which were measured at baseline, after 5 treatment sessions and at the end of treatment. To analyze the data, The Mann Whitney U test and Wilcoxon Signed Rank test were used. After treatment, both US and placebo groups showed statistically significant decrease in FRI scores indicating improvement in functional ability (p = 0.042 and p = 0.043, respectively). The mean changes of FRI during the second five treatment sessions and after the end of treatment was significantly better in the US group than in the placebo group (p = 0.016 and p = 0.032, respectively). Before and after treatment, the mean H reflex latency and Hmax/Mmax ratio, right and left side were similar in the groups (p > 0.05), and no significant changes were observed in the treatment groups (p > 0.05). After treatment, the extension and lateral flexion range of motion significantly increased in the US group (p = 0.04), but the back movements in the placebo group did not show significant changes (p > 0.05). The present study supports the significant effect of US on LBP, and suggests that US may improve the functional ability of patients with non specific low back pain.

Is there any relationship between the Modified Ashworth Scale scores and alpha motoneuron excitability indicators?

The purpose of this study was to investigate the relationship between the modified Ashworth scale (MAS) scores and alpha motoneuron excitability indicators. Thirty-one post-stroke patients were assessed for this object. The main outcome measures were the MAS and electro physiologic assessments. The latter was performed using both conventional (Hmax/Mmax) and new (Hslope/Mslope) measures of spinal excitability. Data on thirty-one adult subjects with hemiplegia (twenty-five men and six women) were analysed. The soleus Hmax/Mmax ratio appeared to correlate directly with the MAS scores (r = 0.36; P < 0.05). Correlation between the MAS scores and either Hslope/Mslope ratio or H-reflex latency was not significant (P > 0.05). In seventeen patients whose H-reflex could be evoked bilaterally, spinal excitability indicators showed significant difference between the affected and non-affected sides (P < 0.05). Based on the results of this study, there is no relationship between the MAS scores and the preferred measure of alpha motoneuron excitability. This research suggests that the MAS could not distinguish between the reflexive and non-reflexive components of the hypertonicity in ankle plantar flexors.

The effect of physiotherapeutic ultrasound on muscle spasticity in patients with hemiplegia: a pilot study.

BACKGROUND: Spasticity is one part of the upper motor neuron syndrome. Untreated spasticity not only causes loss of motor control that results in functional disability, but can easily lead to joint contractures as well. Physical therapy plays an important role in the management of patients with spasticity. Among the modalities, Therapeutic ultrasound has become an important modality for treatment of various conditions including spasticity. OBJECTIVES: The aim of this study is to determine the effect of ultrasound on spasticity. METHODS: In this before-after study, four adult patients (mean age: 57.5 +/- 14.43) with first ever stroke and resulting in hemiplegia participated in the study. The outcome measures were the Ashworth Scale for the assessment of spasticity, ankle passive and active range of motion, and the Hmax: Mmax ratio. RESULTS: The mean of Ashworth scores, Hmax:Mmax ratio, and passive range of motion in ankle joint improved after treatment with ultrasound, but it was not statistically significant (p > 0.05). CONCLUSIONS: The study did not show a significant decrease in spasticity after ultrasound therapy. A study with a large number of patients and a control group would clarify the effects of ultrasound on spasticity.