Effects of sit-to-stand training combined with transcutaneous electrical stimulation on spasticity, muscle strength and balance ability in patients with stroke: A randomized controlled study. Inter-rater reliability of the Modified Modified Ashworth Scale as a clinical tool in measurements of post-stroke elbow flexor spasticity. A single trial of transcutaneous electrical nerve stimulation (TENS) improves spasticity and balance in patients with chronic stroke. Effectiveness of neuromuscular taping on painful hemiplegic shoulder: a randomised clinical trial Effects of repetitive transcranial magnetic stimulation on lower extremity spasticity and motor function in stroke patients Occurence and Clinical Predictors of Spasticity After Ischemic Stroke Impact of botulinum toxin type A on disability and carer burden due to arm spasticity after stroke: a randomised double blind placebo controlled trial The relation between Ashworth scores and neuromechanical measurements of spasticity following stroke Effects of surface electrical stimulation on the muscle–tendon junction of spastic gastrocnemius in stroke patients
Sit-to-st and is a fundamental movement of human being for performing mobility and independent activity . However , Stroke people symptoms experience difficulty in conducting the sit-to-st and due to paralysis and especially ankle spasticity . Recently , transcutaneouselectrical- stimulation ( TENS ) is used to reduce pain but also to manage spasticity . The purpose of this study was to determine ( 1 ) whether TENS would lead to ankle spasticity reduction and ( 2 ) whether sit-to-st and training combined with TENS would improve spasticity , muscle strength and balance ability in stroke patients . Forty-stroke patients were recruited and were r and omly divided into two groups : TENS group ( n=20 ) and sham group ( n=20 ) . All participants underwent 30-sessions of sit-to-st and training ( for 15-min , five-times per week for 6-weeks ) . Prior to each training session , 30-min of TENS over the peroneal nerve was given in TENS group , whereas sham group received non-electrically stimulated TENS for the same amount of time . Composite-Spasticity-Score was used to assess spasticity level of ankle plantar-flexors . Isometric strength in the extensor of hip , knee and ankle were measured by h and held dynamometer . Postural-sway distance was measured using a force platform . The spasticity score in the TENS group ( 2.6±0.8 ) improved significantly greater than the sham group ( 0.7±0.8 , p<0.05 ) . The muscle strength of hip extensor in the TENS group ( 2.7±1.1 kg ) was significantly higher than the sham group ( 1.0±0.8 kg , p<0.05 ) . Significant improvement in postural-sway was observed in the TENS group compared to the sham group ( p<0.05 ) . Thus , sit-to-st and training combined with TENS may be used to improve the spasticity , balance function and muscle strength in stroke patients Patients with neurological conditions may be affected by spasticity . The Modified Modified Ashworth Scale ( MMAS ) is a clinical tool used to measure spasticity . The purpose of the present study was to investigate the inter-rater reliability of the MMAS during the assessment of elbow flexor spasticity in adult patients with post-stroke hemiplegia . Twenty-one adult patients with stroke ( 5 women , 16 men ) with a median age of 60 years ( interquartile range , 47 - 68 ) were tested . Elbow flexors on the affected side were examined . Inter-rater reliability for two inexperienced raters was very good . The weighted Kappa value was 0.81 ( St and ard Error = 0.097 , 95 % CI : 0.62 - 1.00 , p = 0.0002 ) . The weighted percentage agreement was 97.4 % . The agreement between raters occurred mostly on score 1 ( 38.1 % ) followed by score 0 ( 23.8 % ) . The MMAS yielded reliable measurements between raters when used on patients post-stroke with elbow flexor spasticity Spasticity management is pivotal for achieving functional recovery of stroke patients . The purpose of this study was to investigate the effects of a single trial of transcutaneous electrical nerve stimulation ( TENS ) on spasticity and balance in chronic stroke patients . Forty-two chronic stroke patients were r and omly allocated into the TENS ( n = 22 ) or the placebo-TENS ( n = 20 ) group . TENS stimulation was applied to the gastrocnemius for 60 min at 100 Hz , 200 µs with 2 to 3 times the sensory threshold ( the minimal threshold in detecting electrical stimulation for subjects ) after received physical therapy for 30 min . In the placebo-TENS group , electrodes were placed but no electrical stimulation was administered . For measuring spasticity , the resistance encountered during passive muscle stretching of ankle joint was assessed using the Modified Ashworth Scale , and the H and held dynamometer was used to assess the resistive force caused by spasticity . Balance ability was measured using a force platform that measures postural sway generated by postural imbalance . The TENS group showed a significantly greater reduction in spasticity of the gastrocnemius , compared to the placebo-TENS group ( p < 0.05 ) . TENS result ed in greater balance ability improvements , especially during the eyes closed condition ( p < 0.05 ) . However , these effects returned to baseline values within one day . This study shows that TENS provides an immediately effective means of reducing spasticity and of improving balance in chronic stroke patients . The present data may be useful to establish the st and ard parameters for TENS application in the clinical setting of stroke Abstract Purpose : The purpose of this trial was to investigate changes in pain , the range of motion ( ROM ) and spasticity in people with painful hemiplegic shoulder ( PHS ) after the application of an upper limb neuromuscular taping ( NMT ) . Methods : We conducted a r and omised clinical trial . The study included 32 people , 31 % female ( mean ± SD age : 66 ± 9 years ) , with PHS after stroke with pain at rest and during functional movements . The experimental group received the application of NMT and a st and ard physical therapy programme ( SPTP ) , whereas the control group received SPTP . The groups received four 45-minute long sessions over four weeks . The VAS , ROM and spasticity were assessed before and after the intervention with follow-up at four weeks . Results : The experimental group had a greater reduction in pain compared to the control group at the end of the intervention , as well as at one month after the intervention ( p < 0.001 ; all the group differences were greater than 4.5 cm , which is greater than the minimal clinical ly important difference of 2.0 cm ) . The experimental group had a significantly higher ( i.e. better ) ROM , by 30.0 ° , than the control group in shoulder flexion ( 95 % CI : 37.3–22.7 ) at 4 weeks and by 24.8 ° ( 95 % CI : 32.1–17.6 ) at 8 weeks as well as in abduction by 30.6 ° ( 95 % CI : 37.5–23.7 ) at 4 weeks and 25.1 ° ( 95 % CI : 33.8–16.3 ) at 8 weeks . Conclusion : Our study demonstrates that NMT decreases pain and increases the ROM in subjects with shoulder pain after a stroke . Implication s for Rehabilitation Painful hemiplegic shoulder is a frequent complication after stroke with negative impacts on functional activities and on quality of life of people , moreover restricts rehabilitation intervention . Neuromuscular taping is a technique introduced by David Blow for the treatment of neuromuscoloskeletal problems . This study shows the reduction of pain and the improvement of range of motion after the application of an upper limb neuromuscular taping . Rehabilitation professionals who are involved in the management of painful hemiplegic shoulder may like to consider the benefits that neuromuscular taping can produce on upper limb Abstract Purpose : To investigate the effect of low-frequency repetitive transcranial magnetic stimulation ( rTMS ) on lower extremity ( LE ) spasticity , motor function and motor neurone excitability in chronic stroke patients . Method : This study was a r and omised sham-controlled cross-over trial with 1-week follow-up . A total of 20 post-stroke patients were r and omised to receive active ( n = 10 ) or sham ( n = 10 ) rTMS . Fourteen of them ( 7 in each group ) crossed over to the sham or active rTMS after a washout period of 1 month . Interventions consist of five consecutive daily sessions of active or sham rTMS to the unaffected lower extremity motor area ( 1000 pulses ; 1 Hz ; 90 % of the tibialis anterior motor threshold ) . Outcome measures were modified modified ashworth scale ( MMAS ) , the H-reflex , lower extremity section of Fugl – Mayer assessment ( LE-FMA ) and timed UP and GO ( TUG ) test . All outcomes were measured at three levels in each intervention period : pre- and post-intervention and 1-week follow-up . Results : Friedman ’s test revealed significant improvement in MMAS score only after active rTMS . This improvement lasted for one week after the active rTMS . Repeated measure analysis of variance ( ANOVA ) showed significant time*intervention interaction for LE-FMA . There are no differences between groups for the MMAS and LE-FMA . No significant change in Hmax/Mmax ratio and TUG test was noted . Conclusion : Low-frequency rTMS over the LE motor area can improve clinical measures of muscle spasticity and motor function . More studies are needed to clarify the changes underlying this improvement in spasticity . Implication s for Rehabilitation Spasticity is a common disorder and one of the causes of long-term disability after stroke . Physical therapy modalities , oral medications , focal intervention and surgical procedures have been used for spasticity reduction . Beneficial effect of the repetitive transcranial magnetic stimulation ( rTMS ) for post-stroke upper extremity spasticity reduction and motor function improvement was demonstrated in previous studies . This study shows amelioration of lower extremity spasticity and motor function improvement after five daily sessions of inhibitory rTMS to the unaffected brain hemisphere which lasted for at least 1 week following the intervention Background and Purpose — There is currently no consensus on ( 1 ) the percentage of patients who develop spasticity after ischemic stroke , ( 2 ) the relation between spasticity and initial clinical findings after acute stroke , and ( 3 ) the impact of spasticity on activities of daily living and health-related quality of life . Methods — In a prospect i ve cohort study , 301 consecutive patients with clinical signs of central paresis due to a first-ever ischemic stroke were examined in the acute stage and 6 months later . At both times , the degree and pattern of paresis and muscle tone , the Barthel Index , and the EQ-5D score , a st and ardized instrument of health-related quality of life , were evaluated . Spasticity was assessed on the Modified Ashworth Scale and defined as Modified Ashworth Scale > 1 in any of the examined joints . Results — Two hundred eleven patients ( 70.1 % ) were reassessed after 6 months . Of these , 42.6 % ( n=90 ) had developed spasticity . A more severe degree of spasticity ( Modified Ashworth Scale ≥3 ) was observed in 15.6 % of all patients . The prevalence of spasticity did not differ between upper and lower limbs , but in the upper limb muscles , higher degrees of spasticity ( Modified Ashworth Scale ≥3 ) were more frequently ( 18.9 % ) observed than in the lower limbs ( 5.5 % ) . Regression analysis used to test the differences between upper and lower limbs showed that patients with more severe paresis in the proximal and distal limb muscles had a higher risk for developing spasticity ( P≤0.001 ) . Spasticity of the upper and lower limb was more frequent in patients with hemihypesthesia than in patients without sensory deficits ( P≤0.001 ) . Patients with spasticity showed a lower Barthel Index and EQ-5D score compared with the group without spasticity . Conclusions — Spasticity was present in 42.6 % of patients with initial central paresis . However , severe spasticity was relatively rare . Predictors for the development of spasticity were a severe degree of paresis and hemihypesthesia at stroke onset OBJECTIVES After stroke , abnormal arm posture due to spasticity in a functionally useless arm may interfere with self care tasks . In these patients botulinum toxin treatment presents an opportunity to reduce disability . The purpose was to investigate whether reduction in spasticity after botulinum toxin treatment translates into reduction in disability and carer burden . METHODS Forty patients with stroke with spasticity in a functionally useless arm ( median duration 3.1 years ) were r and omised to receive  intramuscular botulinum toxin type A ( BT-A ; Dysport ) ( n=20 ) or placebo ( n=20 ) in a total dose of 1000 MU divided between elbow , wrist , and finger flexors . Spasticity ( using the modified Ashworth scale ) , muscle power , joint movement , and pain were assessed . Disability and carer burden were measured using an eight item and a four item scale respectively . Two baseline and three post-treatment assessment s ( weeks 2 , 6 , and 12 ) were made . Concurrent treatments as far as possible remained unchanged and not optimised . RESULTS Disability improved at week 6 with BT-A compared with placebo . This effect , present at week 2 , wore off by week 12 . Reduction in carer burden was seen at week 6 with BT-A and continued for at least 12 weeks . Forearm flexor spasticity was reduced with BT-A up to 12 weeks after treatment . Although significant improvement in elbow flexor spasticity was seen at week 2 with BT-A compared with placebo , this effect was not evident at weeks 6 and 12 . Arm pain was not improved after BT-A. Grip strength was reduced with BT-A. No serious BT-A related adverse effects were reported . CONCLUSION BT-A is useful for treating patients with stroke who have self care difficulties due to arm spasticity . The decision to treat should also include relief of carer burden . As muscle weakness may occur , its potential impact on functional activities must be assessed before intervention Background Spasticity is a common impairment that follows stroke , and it results typically in functional loss . For this reason , accurate quantification of spasticity has both diagnostic and therapeutic significance . The most widely used clinical assessment of spasticity is the modified Ashworth scale ( MAS ) , an ordinal scale , but its validity , reliability and sensitivity have often been challenged . The present study addresses this deficit by examining whether quantitative measures of neural and muscular components of spasticity are valid , and whether they are strongly correlated with the MAS . Methods We applied abrupt small amplitude joint stretches and Pseudor and om Binary Sequence ( PRBS ) perturbations to both paretic and non-paretic elbow and ankle joints of stroke survivors . Using advanced system identification techniques , we quantified the dynamic stiffness of these joints , and separated its muscular ( intrinsic ) and reflex components . The correlations between these quantitative measures and the MAS were investigated . Results We showed that our system identification technique is valid in characterizing the intrinsic and reflex stiffness and predicting the overall net torque . Conversely , our results reveal that there is no significant correlation between muscular and reflex torque/stiffness and the MAS magnitude . We also demonstrate that the slope and intercept of reflex and intrinsic stiffnesses plotted against the joint angle are not correlated with the MAS . Conclusion Lack of significant correlation between our quantitative measures of stroke effects on spastic joints and the clinical assessment of muscle tone , as reflected in the MAS suggests that the MAS does not provide reliable information about the origins of the torque change associated with spasticity , or about its contributing components Purpose : The purpose of this study was to explore the effects of spasticity suppression by surface electrical stimulation ( ES ) on the muscle – tendon junction of spastic gastrocnemius muscles in stroke . Methods : Twenty-four neurologically stable stroke patients ( aged 41 – 69 years , 12 – 35 months post-stroke ) , with spasticity grade d 2 or 3 on the modified Ashworth scale , were recruited and divided into two groups . In the ES group , each patient received 20 min of surface ES once daily , 6 days per week for 1 month . In the control group , ES was used with stimulation intensity kept at zero . To evaluate the therapeutic effect , the modified Ashworth scale , Fmax/Mmax ratio , H-reflex latency , H-reflex recovery curve , and the 10-m walking time were tested before and after the 1-month treatment . Results : In the ES group , the modified Ashworth Scale showed a trend toward reduced spasticity after 1 month of treatment . The Fmax/Mmax ratio decreased from 8.10 % ± 4.84 % to 4.00 % ± 1.36 % ; the H-reflex latency increased from 28.87 ± 2.45 ms to 29.40 ± 2.57 ms ; the H-reflex recovery curves indicated a downward shift ; and the 10-metre walking time significantly decreased after ES . In the control group , none of the measures showed a statistically significant change . Conclusions : In the study , we demonstrated a way to suppress spasticity at a metameric site and to increase walking speed effectively by applying surface ES on the muscle – tendon junction of spastic gastrocnemius muscles
None of the review ed measurement tools demonstrated satisfactory results for all psychometric properties evaluated , and the majority lacked evidence concerning validity and absolute reliability .
This systematic review found limited evidence to support the use of most of clinical measures of spasticity for people post-stroke .
This review identified various clinical measures of spasticity that have been investigated in people after stroke .
PURPOSE To identify and appraise the literature on clinical measures of spasticity that has been investigated in people after stroke .