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Impairment of functions of the nervous system
Published in Ramar Sabapathi Vinayagam, Integrated Evaluation of Disability, 2019
The descending input from the motor cortex modulates the intrinsic circuit existing in the spinal cord. The input from the intrinsic circuit either exerts an excitatory or inhibitory effect on alpha and gamma motor neurons. Interruption of these descending inputs results in increased activation of alpha and gamma motor neurons causing an increase in resting muscle tone. Alpha motor neurons activate the extrafusal muscle fibers, and any lesion in the alpha motor neurons results in decrease or loss of muscle tone (25). The “Modified Ashworth Scale” describes grading of hypertonia (26). Integrated Evaluation of Disability has developed a method to grade hypotonia of the muscle (Illustration 6.2).
Clinical Management of Spasticity and Contractures in Stroke
Published in Anand D. Pandyan, Hermie J. Hermens, Bernard A. Conway, Neurological Rehabilitation, 2018
Judith F. M. Fleuren, Jaap H. Buurke, Alexander C. H. Geurts
After stroke, upper extremity weakness is the most common impairment, occurring in about 80% of patients (Langhorne et al., 2009). Only 5 to 20% fully recover (Nakayama et al., 1994; Kwakkel and Kollen, 2013). It was found that the prevalence of spasticity in the upper limb one year after stroke, in a group of patients with initially impaired upper limb function, was 46% (Opheim et al., 2014).The severity of spasticity, measured with the Modified Ashworth Scale, increased during the first year. Presence of spasticity after 1 year was associated with poorer sensorimotor function, more pain, reduced range of motion, and reduced sensibility.
Management of residual physical deficits
Published in Mark J. Ashley, David A. Hovda, Traumatic Brain Injury, 2017
Velda L. Bryan, David W. Harrington, Michael G. Elliott
The Modified Ashworth Scale (MAS)39 and the Modified Tardieu Scale (MTS)40 have been the most prominently used scales in the past. In the previous edition of this text, we reported that there was controversy regarding the “determination of the most reliable assessment format.” At that time, studies to determine the most reliable scale provided no clear accord. The MAS and the MTS continue to be used, and more recent research has given them passing grades. Patrick and Ada40 noted that the MTS “differentiates spasticity from contractures whereas the MAS is confounded by it” (p. 173).41 A new scale, the Triple Spasticity Scale (TSS), has been researched by Li, Wu, and Xiong42 and found to have good test–retest reliability and inter-rater reliability in the measurement of muscle tone. The TSS is reported to avoid some of the shortcomings of the previous scales. The one caveat to keep in mind is the one regarding the MAS issue with contractures. In the future, it is possible that the existing scales will be adjusted further or an entirely new scale could emerge.
Assessment of spasticity: an overview of systematic reviews
Published in Physical Therapy Reviews, 2022
Saleh M. Aloraini, Emtenan Y. Alyosuf, Lamya I. Aloraini, Mishal M. Aldaihan
Numerous tools are available for assessing spasticity either in clinical or research settings. However, spasticity measures can generally be classified as clinical, biomechanical or neurophysiological scales [7, 13]. Notably, the most common method used to assess spasticity in the clinical setting appears to be modified Ashworth scale (MAS) [14, 19]. However, the validity of the MAS has been questioned numerous times as it confounds the neurological component of spasticity with other mechanically related components of resistance (e.g. soft tissue changes) [17]. As such, more objective methods (e.g. electromyography [EMG]) have been investigated and can be used to assess spasticity [2, 13, 14, 20, 21]. However, instrumented methods have often been criticized for their lack of feasibility in clinical settings [10, 14], as these methods require training, are time-consuming and are not necessarily affordable by clinics [17]. Indeed, the complexity of spasticity renders its assessment difficult and controversial. However, it still remains important to address the measurement of spasticity and improve clinical practices when assessing spasticity.
Massage therapy as a complementary and alternative approach for people with multiple sclerosis: a systematic review
Published in Disability and Rehabilitation, 2022
Zakieh Heidari, Shahnaz Shahrbanian, Chungyi Chiu
Two studies examined the effect of massage programs on spasticity [17,26] in PwMS. In the study by Negahban et al. [17], spasticity was reduced significantly in the massage therapy group in comparison with control group (Swedish massage vs. control at large ES, Swedish massage vs. massage–exercise at medium ES, Swedish massage vs. exercise; medium ES). However, participants in the exercise therapy groups did not experience a significance reduction in spasticity when compared with the massage therapy group. Siev-Ner et al. [26] reported that the reflexology treatment decreased spasticity (p = 0.03) significantly (Reflexology therapy vs. control at small ES; pre- vs. post-Reflexology therapy at small ES). The Modified Ashworth Scale [17] and the Ashworth Scale [26] were used.
The Hua-Shan rehabilitation program after contralateral seventh cervical nerve transfer for spastic arm paralysis
Published in Disability and Rehabilitation, 2022
Jie Li, Ying Ying, Fan Su, Liwen Chen, Jingrui Yang, Jie Jia, Xiaofeng Jia, Wendong Xu
Participants underwent the same clinical evaluations at baseline and follow-up, including the demographic information, the history of past illness, arm function and ADL. The Fugl-Meyer scale (total scores range from 0 to 66, with higher scores reflecting better function) were used to assess arm function, and we also refined the total score to shoulder&elbow domain and wrist&finger domain. The manual muscle test was utilized to access the muscle strength of triceps brachii, extensor carpi and extensor digitorum. Regarding the measurement of spasticity, the modified ashworth scale was used. The Barthel index was employed to evaluate the ADL. Further, the accomplishments of activities including dressing, tying shoes, wringing out a towel, and operating a mobile phone [4] were used to assess the functional use of the limb. The Chedoke Arm and Hand Activity Inventory served as a reference to evaluate whether the subjects can perform the daily life mentioned above. Patients with a score of 5–7 were defined as being able to complete the task, while those with a score of 1–4 were defined as being unable to complete. The results were initially evaluated by self-report and then confirmed by assessors.